3-d printing of bone grafts

ABSTRACT

Computer implemented methods of producing a bone graft are provided. These methods include obtaining a 3-D image of an intended bone graft site; generating a 3-D digital model of the bone graft based on the 3-D image of the intended bone graft site, the 3-D digital model of the bone graft being configured to fit within a 3-D digital model of the intended bone graft site; storing the 3-D digital model on a database coupled to a processor, the processor having instructions for retrieving the stored 3-D digital model of the bone graft and for combining a carrier material with, in or on a bone material based on the stored 3-D digital model and for instructing a 3-D printer to produce the bone graft. A layered 3-D printed bone graft prepared by the computer implemented method is also provided.

BACKGROUND

Three-dimensional (3-D) printing is an additive printing process used tomake three-dimensional solid objects from a digital model. 3-D printingtechniques are considered additive processes because they involve theapplication of successive layers of material.

3-D printing technology is applied in various industries formanufacturing and planning. For example, the automotive, aerospace andconsumer goods industries use 3-D printing to create prototypes of partsand products. 3-D printing has also been used in the architecturalindustry for printing structural models. The applications of 3-Dprinting in private and government defense have grown rapidly as well.

Traditional 3-D printing allows an object to be created by depositing amaterial over a flat fabrication platform one layer at a time. Once afirst layer is deposited, a second layer is deposited on top of thefirst layer. The process is repeated as necessary to create amulti-laminate solid object. However, 3-D printing does not allow forcontinuous extrusion to create an object. 3-D printing also has not beenwidely appreciated for use in manufacturing bone grafts used to repairbone defects.

Bone defects may be caused by a number of different factors including,but not limited to, trauma, pathological disease or surgicalintervention. Because bone provides both stability and protection to anorganism, these defects can be problematic. In order to address thesedefects, compositions that contain both natural and synthetic materialshave been developed. These compositions may, depending upon thematerials contained within them, be used to repair tissues and to impartdesirable biological and/or mechanical properties to the bone defect.

Among the known bone repair materials and bone void fillers isautologous cancellous bone. This type of bone has the advantage of beingboth osteoinductive and non-immunogenic. Unfortunately, this type ofbone is not available under all circumstances. Moreover, donor sitemorbidity and trauma add to the limitations of autologous cancellousbone.

Generally, bone tissue regeneration is achieved by filling a bone repairsite with a bone graft. Over time, the bone graft is incorporated by thehost and new bone remodels the bone graft. In order to place the bonegraft, it is common to use a monolithic bone graft or to form anosteoimplant comprising particulated bone in a carrier. The carriermaterial is thus chosen to be biocompatible, to be resorbable, and tohave release characteristics such that the bone graft is accessible.Ordinarily, the formed implant, whether monolithic or particulated andin a carrier, is substantially solid at the time of implantation and,thus does not conform to the implant site. Further, the implant issubstantially complete at the time of implantation and thus provideslittle ability for customization, for example, by the addition orsubtraction of autograft material.

Regarding bone grafts, allograft bone is a reasonable bone graftsubstitute for autologous bone. It is readily available from cadaversand avoids the surgical complications and patient morbidity associatedwith harvesting autologous bone. Allograft bone is essentially aload-bearing matrix comprising cross-linked collagen, hydroxyapatite,and osteoinductive bone morphogenetic proteins (BMPs). Human allograftbone is widely used in orthopedic surgery.

Demineralized bone matrix (DBM) is also considered allograft bone,namely, bone from other humans, that has had the inorganic, mineralmaterial removed, leaving behind the organic collagen matrix and BMPsthat induce bone formation. DBM is conducive to osteoinduction, butlacks the load bearing strength.

Traditional methods of 3D printing do not allow for producing acustom-made bone graft by controlling the bone material with, in or onthe carrier material during manufacturing to form the desiredosteoconductive, osteoinductive and/or osteogenic bone graft that aidsin influx and efflux of cells to repair the damaged bone. Thus, there isa need for a computer implemented method of producing a bone grafthaving the desired osteoconductive, osteoinductive and/or osteogenicproperties that can be customized to the intended bone graft site.

SUMMARY

The present disclosure provides a system and method of producing custombone grafts that are made of a biocompatible material that can be usedas ink in a 3-D printer to produce bone grafts of any desired shape. Thepresent disclosure also provides, in some embodiments, a system andmethod of producing custom bone grafts that contain a bioactive agentthat can be released at the bone graft site.

In some embodiments, there is a computer implemented method forproducing a bone graft. The method comprises obtaining a 3-D image of anintended bone graft site; generating a 3-D digital model of the bonegraft based on the 3-D image of the intended bone graft site, the 3-Ddigital model of the bone graft being configured to fit within the bonegraft site. The method also includes storing the 3-D digital model on adatabase coupled to a processor, the processor having instructions forretrieving the stored 3-D digital model of the bone graft and forcombining a carrier material (e.g., biodegradable polymer) with, in oron a bone material based on the stored 3-D digital model and forinstructing a 3-D printer to produce the bone graft.

According to other aspects, provided is a layered 3-D printed bonegraft. In some embodiments, the layered bone graft comprises a firstlayer of biodegradable polymer, a second layer of bone material disposedon the first layer of biodegradable polymer, a third layer ofbiodegradable polymer disposed on the second layer, each layer repeatinguntil a 3-D printer has completed the layered bone graft. In otherembodiments, the layered 3-D printed bone graft comprises a first layerof biodegradable polymer mixed with bone material; a second layer ofbiodegradable polymer mixed with bone material, the second layerdisposed on the first layer, a third layer of biodegradable polymermixed with bone material, the third layer disposed on the second layer,each layer repeating until the 3-D printer has completed the layeredbone graft.

According to other embodiments, provided is a method of treating a bonedefect in a patient in need thereof. In certain aspects, the methodcomprises administering a layered 3-D printed bone graft to the bonedefect, wherein the layered 3-D printed bone graft comprises a firstlayer of biodegradable polymer, a second layer of bone material disposedon the first layer of biodegradable polymer, a third layer ofbiodegradable polymer disposed on the second layer, each layer repeatinguntil a 3-D printer has completed the layered bone graft. In otheraspects, the method of treatment includes administering a layered 3-Dprinted bone graft which comprises a first layer of biodegradablepolymer mixed with bone material, a second layer of biodegradablepolymer mixed with bone material, the second layer disposed on the firstlayer, a third layer of biodegradable polymer mixed with bone material,the third layer disposed on the second layer, each layer repeating untilthe 3-D printer has completed the layered bone graft.

While multiple embodiments are disclosed, still other embodiments of thepresent application will become apparent to those skilled in the artfrom the following detailed description, which is to be read inconnection with the accompanying drawings. As will be apparent, thepresent disclosure is capable of modifications in various obviousaspects, all without departing from the spirit and scope of the presentdisclosure. Accordingly, the detailed description is to be regarded asillustrative in nature and not restrictive.

BRIEF DESCRIPTION OF THE FIGURES

In part, other aspects, features, benefits and advantages of theembodiments will be apparent regarding the following description,appended claims and accompanying drawings.

FIG. 1 illustrates a perspective view of an exemplary 3-D printingdevice according to an aspect of the present application. The 3-Dprinting device includes a rotatable printing surface to facilitatecontinuous extrusion of a predetermined hollow implant.

FIG. 2 illustrates a perspective view of components of an exemplary 3-Dprinting device according to an aspect of the present application.Specifically, shown is a printing surface having a cylindrical shapeconfigured to create a cylindrically shaped hollow structure, such as amesh bag. The printing surface is adjacent to and/or contacts a printhead.

FIG. 3 illustrates a perspective view of components of an exemplary 3-Dprinting device according to an aspect of the present application.Specifically, shown is a printing surface having a rectangularcross-section configured to create a rectangular or square shaped hollowstructure, such as a mesh bag.

FIG. 4 illustrates a perspective view of an exemplary hollow structurecreated through use of a 3-D printing device, according to an aspect ofthe present application. The depicted hollow structure includes arectangular cross-section.

FIG. 5 illustrates a perspective view of components of an exemplary 3-Dprinting device according to an aspect of the present application.Specifically, shown is the movement of a printing surface while a printhead, such as, for example, an applicator continuously extrudes materialto the surface to form a mesh pattern.

FIG. 5A illustrates a perspective view of a mesh bag having a hollowinterior region formed from a 3-D printing device according to an aspectof the present application.

FIG. 5B illustrates a perspective view of a mesh bag as in FIG. 5Acontaining an osteogenic material in a hollow interior region orcompartment.

FIG. 6 illustrates a side view of components of an exemplary 3-Dprinting device according to an aspect of the present application.Specifically, shown is a print head which processes material to beextruded to the printing surface.

FIG. 7 illustrates a side view of components of an exemplary 3-Dprinting device according to an aspect of the present application.Specifically, shown is a radiation source, such as, for example, a lasermounted adjacent the print head to apply an energy to sinter or melt thematerial discharged from the print head.

FIG. 8 illustrates an embodiment of a computer-implemented system forproducing a hollow structure, such as a mesh bag.

FIG. 9 is a flow diagram illustrating an embodiment of thecomputer-implemented system for producing a hollow structure, such as amesh bag.

FIG. 10 is a flow diagram illustrating an embodiment of a system forproducing a hollow structure, such as a mesh implant or bag, through theuse of a 3-D printing machine having a rotating printing surface.

FIG. 11 is a flow diagram illustrating representative steps that thelogic performs for producing a bone graft according to an embodiment ofthis application.

FIG. 12 is a flow diagram illustrating representative steps that thelogic performs for producing a bone graft according to an embodiment ofthis application.

FIG. 13 illustrates an embodiment of a 3-D printed bone graft that iscustom made to fit in the intended bone graft site.

FIG. 14 illustrates a view of a human femur showing a 3-D printed bonegraft of the present application that is implanted into the intendedbone graft site.

FIG. 15 illustrates a partial view of the human vertebral column showinga 3-D printed disc-shaped bone graft of the present application beingimplanted at an intended bone graft site, which is an intervertebralsite.

FIG. 16 illustrates a cross-sectional view of a 3-D printed bone graftof the current application that has allograft tissue partially enclosedby layers of polymers that is custom made to fit in the intended bonegraft site.

FIG. 17 illustrates an enlarged perspective view of a 3-D printed bonegraft of the current application that has allograft tissue partiallyenclosed by layers of polymers that form strips that are custom made tofit in the intended bone graft site.

It is to be understood that the figures are not drawn to scale. Further,the relation between objects in a figure may not be to scale, and may infact have a reverse relationship as to size. The figures are intended tobring understanding and clarity to the structure of each object shown,and thus, some features may be exaggerated in order to illustrate aspecific feature of a structure.

DETAILED DESCRIPTION Definitions

For the purposes of this specification and appended claims, unlessotherwise indicated, all numbers expressing quantities of ingredients,percentages or proportions of materials, reaction conditions, and othernumerical values used in the specification and claims, are to beunderstood as being modified in all instances by the term “about.”Similarly, when values are expressed as approximations, by use of theantecedent “about,” it will be understood that the particular valueforms another embodiment that is +/−10% of the recited value.Accordingly, unless indicated to the contrary, the numerical parametersset forth in the following specification and attached claims areapproximations that may vary depending upon the desired propertiessought to be obtained by the present disclosure. At the very least, andnot as an attempt to limit the application of the doctrine ofequivalents to the scope of the claims, each numerical parameter shouldat least be construed in light of the number of reported significantdigits and by applying ordinary rounding techniques. Also, as used inthe specification and including the appended claims, the singular forms“a,” “an,” and “the” include the plural, and reference to a particularnumerical value includes at least that particular value, unless thecontext clearly dictates otherwise. Ranges may be expressed herein asfrom “about” or “approximately” one particular value and/or to “about”or “approximately” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value.

Notwithstanding that the numerical ranges and parameters setting forththe broad scope of this application are approximations, the numericalvalues set forth in the specific examples are reported as precisely aspossible. Any numerical value, however, inherently contains certainerrors necessarily resulting from the standard deviation found in theirrespective testing measurements. Moreover, all ranges disclosed hereinare to be understood to encompass any and all subranges subsumedtherein. For example, a range of “1 to 10” includes any and allsubranges between (and including) the minimum value of 1 and the maximumvalue of 10, that is, any and all subranges having a minimum value ofequal to or greater than 1 and a maximum value of equal to or less than10, for example, 5.5 to 10.

Allograft, as used herein, refers to a graft of tissue obtained from adonor of the same species as, but with a different genetic make-up fromthe recipient, as a tissue transplant between two humans.

The bone graft can have a bioactive agent disposed in or on the bonegraft. Bioactive agent or bioactive compound is used herein to refer toa compound or entity that alters, inhibits, activates, or otherwiseaffects biological or chemical events. For example, bioactive agents mayinclude, but are not limited to, osteogenic or chondrogenic proteins orpeptides, anti-AIDS substances, anti-cancer substances, antibiotics,immunosuppressants, anti-viral substances, enzyme inhibitors, hormones,neurotoxins, opioids, hypnotics, anti-histamines, lubricants,tranquilizers, anti-convulsants, muscle relaxants and anti-Parkinsonsubstances, anti-spasmodics and muscle contractants including channelblockers, miotics and anti-cholinergics, anti-glaucoma compounds,anti-parasite and/or anti-protozoal compounds, modulators ofcell-extracellular matrix interactions including cell growth inhibitorsand antiadhesion molecules, vasodilating agents, inhibitors of DNA, RNAor protein synthesis, anti-hypertensives, analgesics, anti-pyretics,steroidal and non-steroidal anti-inflammatory agents, clonidine, astatin, bone morphogenetic protein, anti-angiogenic factors, angiogenicfactors, anti-secretory factors, anticoagulants and/or antithromboticagents, local anesthetics, prostaglandins, anti-depressants,anti-psychotic substances, anti-emetics, and imaging agents. In certainembodiments, the bioactive agent is a drug. Bioactive agents furtherinclude RNAs, such as siRNA, and osteoclast stimulating factors. In someembodiments, the bioactive agent may be a factor that stops, removes, orreduces the activity of bone growth inhibitors. In some embodiments, thebioactive agent is a growth factor, cytokine, extracellular matrixmolecule or a fragment or derivative thereof, for example, a cellattachment sequence such as RGD.

Biocompatible, as used herein, is intended to describe materials that,upon administration in vivo, do not induce undesirable long-termeffects.

Biodegradable includes compounds or components that will degrade overtime by the action of enzymes, by hydrolytic action and/or by othersimilar mechanisms in the human body. In various embodiments,“biodegradable” includes that components can break down or degradewithin the body to non-toxic components as cells (e.g., bone cells)infiltrate the components and allow repair of the defect. By“biodegradable” it is meant that the compounds or components will erodeor degrade over time due, at least in part, to contact with substancesfound in the surrounding tissue, fluids or by cellular action. By“bioabsorbable” it is meant that the compounds or components will bebroken down and absorbed within the human body, for example, by a cellor tissue. “Biocompatible” means that the compounds or components willnot cause substantial tissue irritation or necrosis at the target tissuesite and/or will not be carcinogenic.

Bone, as used herein, refers to bone that is cortical, cancellous orcortico-cancellous of autogenous, allogenic, xenogenic, or transgenicorigin.

Bone graft, as used herein, refers to any implant prepared in accordancewith the embodiments described herein and therefore may includeexpressions such as bone material and bone membrane.

Demineralized, as used herein, refers to any material generated byremoving mineral material from tissue, for example, bone tissue. Incertain embodiments, demineralized bone material may be added to thebone graft. The demineralized bone material described herein includepreparations containing less than 5%, 4%, 3%, 2% or 1% calcium byweight. Partially demineralized bone (for example, preparations withgreater than 5% calcium by weight but containing less than 100% of theoriginal starting amount of calcium) is also considered within the scopeof the disclosure. In some embodiments, partially demineralized bonecontains preparations with greater than 5%, 10%, 150%, 20%, 25%, 30%,35%, 400%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%,97%, 98% or 99% of the original starting amount of calcium. In someembodiments, demineralized bone has less than 95% of its originalmineral content. In some embodiments, demineralized bone has less than95%, 90%, 85%, 80%, 75%, 70%, 65%, 60%, 55%, 50%, 45%, 40%, 35%, 30%,25%, 20%, 15%, 10%, or 5% of its original mineral content. Demineralizedis intended to encompass such expressions as “substantiallydemineralized,” “partially demineralized,” “superficiallydemineralized,” and “fully demineralized.” In some embodiments, part orthe entire surface of the bone can be demineralized. For example, partor the entire surface of the bone material can be demineralized to adepth of from about 100 to about 5000 microns, or about 150 microns toabout 1000 microns. In some embodiments, part or all of the surface ofthe bone material can be demineralized to a depth of from about 100,150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800,850, 900, 950, 1000, 1050, 1100, 1150, 1200, 1250, 1300, 1350, 1400,1450, 1500, 1550, 1600, 1650, 1700, 1750, 1800, 1850, 1900, 1950, 2000,2050, 2100, 2150, 2200, 2250, 2300, 2350, 2400, 2450, 2500, 2550, 2600,2650, 2700, 2750, 2800, 2850, 2900, 2950, 3000, 3050, 3100, 3150, 3200,3250, 3300, 3350, 3400, 3450, 3500, 3550, 3600, 3650, 3700, 3750, 3800,3850, 3900, 3950, 4000, 4050, 4100, 4150, 4200, 4250, 4300, 4350, 4400,4450, 4500, 4550, 4600, 4650, 4700, 4750, 4800, 4850, 4900, 4950 toabout 5000 microns. If desired, the bone void filler can comprisedemineralized material.

Partially demineralized bone is intended to refer to preparations withgreater than 5% calcium by weight but containing less than 100% of theoriginal starting amount of calcium. In some embodiments, partiallydemineralized bone comprises 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16,17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34,35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52,53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70,71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88,89, 90, 91, 92, 93, 94, 95, 96, 97, 98 and/or 99% of the originalstarting amount of calcium.

In some embodiments, the demineralized bone may be surface demineralizedfrom about 1-99%. In some embodiments, the demineralized bone is 1, 2,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22,23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40,41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58,59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76,77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94,95, 96, 97, 98 and/or 99% surface demineralized. In various embodiments,the demineralized bone may be surface demineralized from about 15-25%.In some embodiments, the demineralized bone is 15, 16, 17, 18, 19, 20,21, 22, 23, 24 and/or 25% surface demineralized.

Demineralized bone matrix (DBM), as used herein, refers to any materialgenerated by removing mineral material from bone tissue. In someembodiments, the DBM compositions as used herein include preparationscontaining less than 5% calcium and, in some embodiments, less than 1%calcium by weight. In some embodiments, the DBM compositions includepreparations that contain less than 5, 4, 3, 2 and/or 1% calcium byweight. In other embodiments, the DBM compositions comprise partiallydemineralized bone (for example, preparations with greater than 5%calcium by weight but containing less than 100% of the original startingamount of calcium).

Osteoconductive, as used herein, refers to the ability of a substance toserve as a template or substance along which bone may grow.

Osteogenic, as used herein, refers to materials containing living cellscapable of differentiation into bone tissue.

Osteoinductive, as used herein, refers to the quality of being able torecruit cells from the host that have the potential to stimulate newbone formation. Any material that can induce the formation of ectopicbone in the soft tissue of an animal is considered osteoinductive. Forexample, most osteoinductive materials induce bone formation in athymicrats when assayed according to the method of Edwards et al.,“Osteoinduction of Human Demineralized Bone: Characterization in a RatModel,” Clinical Orthopaedics & Rel. Res., 357:219-228, December 1998,incorporated herein by reference.

Osteoimplant is used herein in its broadest sense and is not intended tobe limited to any particular shapes, sizes, configurations,compositions, or applications. Osteoimplant refers to any device ormaterial for implantation that aids or augments bone formation orhealing. An osteoimplant may include any material, such as allograft,xenograft, or synthetic material, used to promote or support bonehealing. The osteoimplant may be homogeneous or heterogeneous.Osteoimplants are often applied at a bone defect site, e.g., oneresulting from injury, defect brought about during the course ofsurgery, infection, malignancy, inflammation, or developmentalmalformation. Osteoimplants can be used in a variety of orthopedic,neurosurgical, dental, oral and maxillofacial surgical procedures suchas the repair of simple and compound fractures and non-unions, external,and internal fixations, joint reconstructions such as arthrodesis,general arthroplasty, deficit filling, discectomy, laminectomy, anteriorcervical and thoracic operations, or spinal fusions.

DBM preparations have been used for many years in orthopedic medicine topromote the formation of bone. For example, DBM has found use in therepair of fractures, in the fusion of vertebrae, in joint replacementsurgery, and in treating bone destruction due to underlying disease suchas a bone tumor. DBM has been shown to promote bone formation in vivo byosteoconductive and osteoinductive processes. The osteoinductive effectof implanted DBM compositions results from the presence of active growthfactors present on the isolated collagen-based matrix. These factorsinclude members of the TGF-R, IGF, and BMP protein families. Particularexamples of osteoinductive factors include TGF-β, IGF-1, IGF-2, BMP-2,BMP-7, parathyroid hormone (PTH), and angiogenic factors. Otherosteoinductive factors such as osteocalcin and osteopontin are alsolikely to be present in DBM preparations as well. There are also likelyto be other unnamed or undiscovered osteoinductive factors present inDBM.

Superficially demineralized, as used herein, refers to bone-derivedelements possessing at least about 90 weight percent of their originalinorganic mineral content. In some embodiments, superficiallydemineralized contains at least about 90, 91, 92, 93, 94, 95, 96, 97, 98and/or 99 weight percent of their original inorganic material. Theexpression “fully demineralized” as used herein refers to bonecontaining less than 8% of its original mineral context. In someembodiments, fully demineralized contains about less than 8, 7, 6, 5, 4,3, 2 and/or 1% of its original mineral content.

The expression “average length to average thickness ratio” as applied tothe DBM fibers of the present application means the ratio of the longestaverage dimension of the fiber (average length) to its shortest averagedimension (average thickness). This is also referred to as the “aspectratio” of the fiber.

Fibrous, as used herein, refers to bone elements whose average length toaverage thickness ratio or aspect ratio of the fiber is from about 50:1to about 1000:1. In some embodiments, average length to averagethickness ratio or aspect ratio of the fiber is from about 50:1, 75:1,100:1, 125:1, 150:1, 175:1, 200:1, 225:1, 250:1, 275:1, 300:1, 325:1,350:1, 375:1, 400:1, 425:1, 450:1, 475:1, 500:1, 525:1, 550:1, 575:1,600:1, 625:1, 650:1, 675:1, 700:1, 725:1, 750:1, 775:1, 800:1, 825:1,850:1, 875:1, 900:1, 925:1, 950:1, 975:1 and/or 1000:1. In overallappearance, the fibrous bone elements can be described as bone fibers,threads, narrow strips, or thin sheets. Often, where thin sheets areproduced, their edges tend to curl up toward each other. The fibrousbone elements can be substantially linear in appearance or they can becoiled to resemble springs. In some embodiments, the bone fibers are ofirregular shapes including, for example, linear, serpentine or curvedshapes. The bone fibers are preferably demineralized however some of theoriginal mineral content may be retained when desirable for a particularembodiment. In various embodiments, the bone fibers are mineralized. Insome embodiments, the fibers are a combination of demineralized andmineralized.

Non-fibrous, as used herein, refers to elements that have an averagewidth substantially larger than the average thickness of the fibrousbone element or aspect ratio of less than from about 50:1 to about1000:1. The non-fibrous bone elements may be shaped in a substantiallyregular manner or specific configuration, for example, triangular prism,sphere, cube, cylinder and other regular shapes. By contrast, particlessuch as chips, shards, or powders possess irregular or randomgeometries. It should be understood that some variation in dimensionwill occur in the production of the elements of this application andelements demonstrating such variability in dimension are within thescope of this application and are intended to be understood herein asbeing within the boundaries established by the expressions “mostlyirregular” and “mostly regular.”

The bone implant devices and methods according to the presentapplication increase DBM content in the device, increase the surfacearea of the DMB, and uniformly distribute the DBM throughout thedelivery device to enhance bone growth when the delivery device isimplanted at a bone defect. The bone implant devices and methodsprovided enhance bone growth by reducing the gaps that may exist betweenthe DBM particles and reduce the distance for cells (for example,osteoclasts, osteoblasts, etc.) to travel throughout the device to allowthose cells to receive an adequate osteoinductive signal as opposed toonly along the surface of the device. In some embodiment, the deviceimproves the fusion of adjacent interspinous processes.

The abbreviation “DLG” refers to poly(DL-lactide-co-glycolide).

The abbreviation “PDL” refers to poly(DL-lactide).

The abbreviation “PLG” refers to poly(L-lactide-co-glycolide).

The abbreviation “PCL” refers to polycaprolactone.

The abbreviation “DLCL” refers to poly(DL-lactide-co-caprolactone).

The abbreviation “LCL” refers to poly(L-lactide-co-caprolactone).

The abbreviation “PPG” refers to polyglycolide.

The abbreviation “PEG” refers to poly(ethylene glycol).

The abbreviation “PLGA” refers to poly(lactide-co-glycolide) also knownas poly(lactic-co-glycolic acid), which are used interchangeably.

The abbreviation “PLA” refers to polylactide.

The abbreviation “PEA” refers to poly(ester)amides.

The abbreviation “POE” refers to poly(orthoester).

The terms “three-dimensional printing system,” “three-dimensionalprinter,” “printing,” describe various solid freeform fabricationtechniques for making three-dimensional articles or objects by selectivedeposition, jetting, fused deposition modeling, multijet modeling, andother additive manufacturing techniques now known in the art or that maybe known in the future that use a build material or ink to fabricatethree-dimensional objects.

Reference will now be made in detail to certain embodiments of theinvention, examples of which are illustrated in the accompanyingdrawings. While the invention will be described in conjunction with theillustrated embodiments, it will be understood that they are notintended to limit the invention to those embodiments. On the contrary,the invention is intended to cover all alternatives, modifications, andequivalents that may be included within the invention as defined by theappended claims.

According to one aspect, there is a 3-D printed bone graft deliverydevice comprising: a porous biodegradable graft body for inducing bonegrowth at a surgical site, the porous biodegradable graft body havingdemineralized bone matrix (DBM) fibers disposed within the porousbiodegradable body, and DBM powder disposed adjacent to, on or in theDBM fibers, wherein the porous biodegradable graft body facilitatestransfer of cells into and out of the porous biodegradable graft body toinduce bone growth at the surgical site.

3-D Printer Device

Provided is 3-D printing devices and methods of use for creating, insome embodiments, hollow structures such as mesh implants or bags. Alsoprovided are 3-D printing devices including a rotatable printing surfaceto create such hollow structures or in some embodiments, solidstructures. Further provided are devices and methods for 3-D printingonto a rotatable printing surface by continuous extrusion instead ofstratified layers. Additionally, provided are devices and methods forcreating structures having a meshed design that are strong, flexible,stretchable and biocompatible.

Turning now to FIGS. 1-7 , provided is a 3-D printing device 10 forfabricating hollow structures, such as mesh bags 70 (e.g., mesh bags ormesh implants). 3-D printing is typically done in 2 dimensions, onelayer at a time. Material is laid out on a flat surface and the threedimensional structures are built up one layer at a time, usually througha melting or sintering process. In some embodiments, a 3-D printerhaving a rotatable printing surface is provided to allow printing hollowstructures, such as, for example, mesh bags. In some embodiments, aprint head applies material to the print surface through continuousextrusion instead of stratified layers, as is done by traditional 3-Dprinting devices. In some embodiments, the 3-D printing device createsstronger structures and generates less waste than traditional 3-Dprinting devices.

As shown in FIG. 1 , provided is 3-D printing device 10 for use in thefabrication of mesh bags 70. 3-D printing device 10 includes a table 14having a base 16 and a printing surface 12. In some embodiments,printing surface 12 is mounted onto table 14 including base 16. Base 16is configured for planar movement. In some embodiments, base 16 ismovable in the x-y plane and is laterally movable in both the x axis andthe y axis for precise positioning of printing surface 12. Printingsurface 12, in some embodiments, is fixedly disposed with table 14 suchthat lateral movement of base 16 causes lateral movement of printingsurface 12. Movement of base 16 allows for positioning of printingsurface 12 relative to a print head 30 to facilitate depositingmaterials onto printing surface 12, as discussed herein.

Printing surface 12 is rotatable about an axis of rotation, as shown inFIGS. 2 and 3 . In some embodiments, rotating printing surface 12includes a cylindrical shape extending along a longitudinal axis, asshown in FIG. 2 . The surface 12 can rotate along B. This allowsprinting of a round or circular implant with a hollow region as theimplant takes on the shape of printing surface 12. The threads 72 mayinclude bone material 74 (e.g., DBM particles, allograft tissueparticles, cortical bone particles, etc.) uniformly disposed throughoutthe threads 72.

In some embodiments, printing surface 12 includes other cross-sectionalshapes, such as, for example, rectangular, oval, polygonal, irregular,undulating, or lobed. For example, as shown in FIG. 3 , printing surface12 may have a rectangular cross-section extending along a longitudinalaxis. The surface 12 can rotate along B. This allows printing of asquare or rectangular implant, as the print surface rotates, the implantwill take the shape of the print surface. In alternative embodiments,printing surface 12 includes a uniform diameter and/or cross-sectionalong its entire length. In other embodiments, printing surface 12includes a changing diameter or cross-section along its length. Forexample, in some embodiments the diameter may increase from one end ofprinting surface 12 to the other. In some embodiments, the cross-sectionof printing surface 12 changes from one end to the other. For example,one end of printing surface 12 may have a circular cross-section whilethe opposite end may have a rectangular cross-section. The size andshape of printing surface 12 may be changed according to thespecifications and needs of a particular medical procedure. In someembodiments, mesh bags 70 are printed onto printing surface 12 intowhich another object, such as for example, bone material (e.g. surfacedemineralized bone chips and fully demineralized bone fibers), can beplaced inside a hollow region or compartment. The shape of printingsurface 12 defines the shape of the hollow structure created. As shownin FIG. 2 , the shape of mesh bag 70 created is cylindrical. As shown inFIG. 4 , the shape of mesh bag 70 created is that of a hollowed outrectangular prism. The threads 72 may include bone material 74 (e.g.,DBM particles, allograft tissue particles, cortical bone particles,etc.) uniformly disposed throughout the threads 72.

Printing surface 12 is rotatable about a rotation of axis defined byextension shaft 20, as discussed herein. In various embodiments,printing surface 12 is rotatable in either clockwise or counterclockwisedirections. In various embodiments, printing surface 12 is rotatable inboth clockwise and counterclockwise directions, as shown by arrow B inFIGS. 2 and 3 . Printing surface 12 is configured to change direction ofrotation multiple times throughout the course of fabrication of a hollowstructure, such as, for example, mesh bag 70, as discussed herein. Forexample, printing surface 12 can rotate along a rotational axis 360degrees clockwise and/or counterclockwise to print the implant.

In some embodiments, printing surface 12 is movable between an expandedconfiguration and a collapsed configuration. In some embodiments, amaterial 40 (which can be a biodegradable polymer) is deposited ontoprinting surface 12 while in the expanded configuration, and printingsurface 12 is moved to the collapsed configuration to remove the printedhollow structure. Print head 30 can contact printing surface 12 or therecan be a gap between printing surface 12 and print head 30 so thatmaterial 40 can be printed on printing surface 12.

In some embodiments, printing surface 12 is fixedly disposed with table14 via a mounting bracket 18. Mounting bracket 18 may include covering15 for protection. In some embodiments, mounting bracket 18 includes amotor to provide a rotational force to move printing surface 12. In someembodiments, mounting bracket 18 is connected to extension shaft 20.Printing surface 12 is connected to extension shaft 20 at a first end ofprinting surface 12. Extension shaft 20 defines an axis of rotation forprinting surface 12 and is connected to mounting bracket 18 via a collet22. In some embodiments, collet 22 is expandable to loosen the grip onextension shaft 20. This allows extension shaft 20 and printing surface12 to be changed out for another printing surface 12 which may be sizedand/or shaped differently to cater to the needs of a particularprocedure.

In some embodiments, 3-D printing device 10 further includes print head30, such as, for example, an applicator that is movable in a directiontransverse to the plane of movement for base 16. In some embodiments,print head 30 is movable in the z axis, as shown by arrow A₁ in FIG. 1 ,to allow for different size fixtures, variable surface structures and tocontrol the thickness of the extruded layer. Thus, print head 30 ismovable to have an adjustable distance from printing surface 12.Additionally, print head 30 is movable to accommodate printing surfaceshaving various diameters or printing surfaces having gradient diameters.In some embodiments, print head 30 is also movable in the x and y planesparallel with the plane of movement for base 16. Thus, in someembodiments, print head 30 is movable in an opposite direction from themovement of printing surface 12 to facilitate faster printing. In someembodiments, print head 30 is suspended from a track 35. Track 35provides a base of support for print head 30. In some embodiments, track35 provides a predefined route of allowable movement for print head 30in directions, shown as C. In some embodiments, track 35 is hollow toallow flow of material 40 to be delivered to printing surface 12, asdescribed herein.

In some embodiments, printing surface 12 is treated with an adhesivematerial. The adhesive material may be textured or coated onto printingsurface 12. The adhesive may be heat sensitive or heat activated suchthat printing surface 12 becomes adhesive to material 40 when printingsurface 12 is heated, as discussed herein. An adhesive coating aids inpreventing printed material 40 from falling off printing surface 12during rotation. In some embodiments, the adhesive is deactivatedthrough cooling. In some embodiments, the adhesive may be removed byplacing printing surface 12 in a solvent to dissolve the adhesivematerial. Once the adhesive material is removed, a hollow structureprinted to printing surface 12 may be removed.

As shown in FIGS. 1 and 6 , print head 30 includes a distal opening 32through which material 40 is deposited on printing surface 12. A tubeportion 31 of print head 30 includes a first diameter and extendsdistally to a head portion 33 having a second diameter. In someembodiments, the second diameter is smaller than the first diameter. Invarious embodiments, material 40 includes a biodegradable polymer. Insome embodiments, material 40 comprises a bioerodible, a bioabsorbable,and/or a biodegradable biopolymer. Examples of suitable biopolymersinclude but are not limited to poly (alpha-hydroxy acids), poly(lactide-co-glycolide) (PLGA), polylactide (PLA), polyglycolide (PG),polyethylene glycol (PEG), conjugates of poly (alpha-hydroxy acids),poly(orthoester)s (POE), polyaspirins, polyphosphagenes, collagen,starch, pre-gelatinized starch, hyaluronic acid, chitosans, gelatin,alginates, albumin, fibrin, vitamin E compounds, such as alphatocopheryl acetate, d-alpha tocopheryl succinate, D,L-lactide, orL-lactide, caprolactone, dextrans, vinylpyrrolidone, polyvinyl alcohol(PVA), PVA-g-PLGA, PEGT-PBT copolymer (polyactive), PEO—PPO-PAAcopolymers, PLGA-PEO-PLGA, PEG-PLG, PLA-PLGA, poloxamer 407,PEG-PLGA-PEG triblock copolymers, SAIB (sucrose acetate isobutyrate) orcombinations thereof. In various embodiments, material 40 comprisespoly(lactide-co-glycolide) (PLGA), polylactide (PLA), polyglycolide(PGA), D-lactide, D,L-lactide, L-lactide, D,L-lactide-co-ε-caprolactone,D,L-lactide-co-glycolide-co-ε-caprolactone, L-lactide-co-ε-caprolactoneor a combination thereof.

Print head 30 includes an inner lumen 34 and a central feed shaft 36 asillustrated in FIG. 6 . Feed shaft 36 is configured to turn feed threads38 to feed material 40 from the proximal end of print head 30 throughopening 32. Material 40 is maintained in an external reservoir (notshown) and fed into lumen 34. In some embodiments, material 40 is driveninto lumen 34 by gravity. In some embodiments material 40 is drawn intolumen 34 by turning feed shaft 36 and feed threads 38. In someembodiments, 3-D printing device includes multiple print heads 30, eachconfigured to deposit material 40 onto printing surface 12.

In some embodiments, as illustrated in FIG. 1 , 3-D printing device 10further includes a temperature control unit 50 such as for example aheating or cooling unit connected to printing surface 12. In someembodiments, temperature control unit 50 includes a heating unit. Inother embodiments, temperature control unit 50 includes a cooling unit.In some embodiments, temperature control unit 50 is used to heatprinting surface 12 through electric heating elements underneath thesurface of printing surface 12. Sufficient energy may be suppliedthrough such electric conduits to provide a temperature on the surfaceof printing surface 12 to melt and bond material 40 applied from printhead 30. In such an embodiment, as illustrated in FIG. 1 , conduits 52are electric heating conduits. In some embodiments, where material 40comprises a highly viscous material, a heated printing surface 12 allowsmaterial 40 to flow. In other embodiments, material 40 is heated orcooled in a reservoir 37 to allow the desired flowability or viscosityof material 40 to make the implant.

In some embodiments, temperature control unit 50 comprises a coolingunit. The cooling unit is used to cool printing surface 12 throughrefrigerant supply and return lines underneath printing surface 12. Insuch an embodiment, the supply and return lines are conduits 52. Theconduits 52 supply cooling fluid to printing surface 12 to cool andsolidify hot material 40 extruded onto the surface. In alternativeembodiments, reservoir 37 can have the cooling and heating unit to allowcooling or heating of material 40.

According to some aspects, 3-D printing device 10 includes a radiationsource configured to supply and transfer energy to at least a portion ofthe powder (e.g., polymer material) applied to the surface. In someembodiments, the radiation source is a laser 60 positioned adjacentprint head 30. Laser 60 articulates such that the supplied beam can befocused on selected portions of printing surface 12. As shown in FIG. 7, laser 60 is configured to be used during or after print head 30deposits material 40 (e.g., polymer material) onto printing surface 12.The beam of laser 60 is focused onto portions of material 40 on printingsurface 12 to melt or sinter material 40 as desired. Once the printedhollow structure is complete, it may be removed from the residualpowdered material 40 left on printing surface 12, or the residualpowdered material 40 is brushed away. In some embodiments, laser 60 isfocused at a point adjacent opening 32 to sinter material 40 as it isdeposited onto printing surface 12. Such embodiments may facilitate theelimination of waste since the majority of material 40 extruded ontoprinting surface 12 is sintered.

In some embodiments, laser 60 may include any wavelength of visiblelight or UV light. In some embodiments, laser 60 emits alternative formsof radiation, such as, for example, microwave, ultrasound or radiofrequency radiation. In some embodiments, laser 60 is configured to befocused on a portion of printing surface 12 to sinter material 40deposited thereon. Laser 60 may be emitted in a beam having a smalldiameter. For example, the diameter of the beam may be between about0.01 mm and about 0.8 mm. In some embodiments, the diameter of the beammay be between about 0.1 mm and about 0.4 mm. In some embodiments, thediameter of the beam is adjustable to customize the intensity of thesintering. In some embodiments, material 40 is deposited on printingsurface 12 and print head 30 removes by, for example, heating material40 to remove unwanted material 40 from printing surface 12 to make theimplant. Material 40 remaining on printing surface 12 after removal ofthe unwanted material 40 will be the implant.

In other aspects, as illustrated in FIG. 8 , 3-D printing device 10includes a controller or processor 102 to accept instructions andautomatically manufacture a hollow structure, such as, for example, amesh bag 70, based on the instructions. In some embodiments, processor102 comprises memory 100 for temporary or permanent storage ofinstructions. Various instructions may be programmed and stored inmemory 100 to make multiple designs of mesh bag 70 and/or mesh coversfor mesh bag 70. In some embodiments, 3-D printing device 10 includes aninput device 106, such as, for example, a keyboard to input commands andinstructions. In some embodiments, processor 102 of 3-D printing device10 is configured to receive commands and instructions from an externalcomputer. For example, various instructions may be stored and executedlocally on an external computer to operate 3-D printing device 10. Insome embodiments, the computer and 3-D printing device 10 can be onesingle device with component parts.

In some embodiments, processor 102 comprises logic to execute one ormore instructions to carry out instructions of the computer system (forexample, transmit instructions to the 3-D printer, etc.). The logic forexecuting instructions may be encoded in one or more tangible media forexecution by processor 102. For example, processor 102 may execute codesstored in a computer-readable medium such as memory 100. Thecomputer-readable medium may be stored in, for example, electronic (forexample, RAM (random access memory), ROM (read-only memory), EPROM(erasable programmable read-only memory), magnetic, optical (forexample, CD (compact disc), DVD (digital video disc)), electromagnetic,semiconductor technology, or any other suitable medium.

In some embodiments, the instructions include dimensions of a mesh bag70 to be made. For example, the instructions may include programming asto the length and thickness of mesh bag 70. Processor 102 carries outthe instructions by causing movement of base 16 relative to print head30 while material 40 is applied to printing surface 12. Additionally,processor 102 may cause movement of print head 30 in a direction awayfrom printing surface 12 to allow for a thicker layer of material 40,according to the predetermined specifications in the instructions. Insome embodiments, processor 102 is configured to provide a single layerof material 40 to make mesh bag 70. The layer of material 40 depositedonto printing surface 12 may have uniform thicknesses or may includevaried thicknesses, such as thickness gradients across the length ofmesh bag 70. In some embodiments, the dimensions of mesh bag 70 mayrange from about 1 cm to about 1 meter in length, or from about 3 cm toabout 8 cm in length, from about 2 mm to about 30 mm in thickness, orfrom about 2 mm to about 10 mm in thickness, and from about 2 mm toabout 30 mm in width, or from about 2 mm to about 10 mm in width.

Once processor 102 receives the instructions, processor 102 directs 3-Dprinting device 10 to make mesh bag 70 based on the receivedinstructions. In some embodiments, processor 102 directs the lateralmovement of base 16 and printing surface 12, and the movement of printhead 30 transverse to base 16 and printing surface 12. In someembodiments, processor 102 also controls the direction of rotation, thedegree of rotation and the speed of rotation of printing surface 12. Insome embodiments, processor 102 moves, focuses and directs laser 60 toemit radiation at a predetermined point on printing surface 12. In someembodiments, processor 102 directs temperature control unit 50 to heator cool printing surface 12. Based on the instructions received,processor 102 coordinates simultaneous and/or ordered movement of base16, printing surface 12, and print head 30 relative to one another.Processor 102 also controls the application of material 40 onto printingsurface 12. For example, processor 102 directs the pressure at whichmaterial 40 is released onto printing surface 12. Processor 102 alsodirects the patterns of application onto printing surface 12, includingportions where material 40 is not applied to printing surface 12 toreduce waste. Processor 102 may also direct laser 60 to emit radiation,such as for example, focused beams of light, in controlled pulses tosinter preselected portions of material 40 on printing surface 12.

In some embodiments, processor 102 directs motors which control themovement and rotation of at least base 16, printing surface 12, andprint head 30 relative to one another. In some embodiments, processor102 directs coarse and/or fine movement of components of 3-D printingdevice 10.

Although the components of the system of FIG. 8 are shown as separate,they may be combined in one or more computer systems. Indeed, they maybe one or more hardware, software, or hybrid components residing in (ordistributed among) one or more local or remote computer systems. It alsoshould be readily apparent that the components of the system asdescribed herein may be merely logical constructs or routines that areimplemented as physical components combined or further separated into avariety of different components, sharing different resources (includingprocessing units, memory, clock devices, software routines, logiccommands, etc.) as required for the particular implementation of theembodiments disclosed. Indeed, even a single general purpose computer(or other processor-controlled device) executing a program stored on anarticle of manufacture (for example, recording medium or other memoryunits) to produce the functionality referred to herein may be utilizedto implement the illustrated embodiments. It also will be understoodthat the plurality of computers or servers can be used to allow thesystem to be a network based system having a plurality of computerslinked to each other over the network or Internet or the plurality ofcomputers can be connected to each other to transmit, edit, and receivedata via cloud computers or in a data drop box.

The computer (for example, memory, processor, storage component, etc.)may be accessed by authorized users. Authorized users may include atleast one engineer, technician, surgeon, physician, nurse, and/or healthcare provider, manufacturer, etc.

The user can interface with the computer via a user interface that mayinclude one or more display devices 104 (for example, CRT, LCD, or otherknown displays) or other output devices (for example, a printer, etc.),and one or more input devices (for example, keyboard, mouse, stylus,touch screen interface, or other known input mechanisms) forfacilitating interaction of a user with the system via user interface.The user interface may be directly coupled to database or directlycoupled to a network server system via the Internet, Wi-Fi or cloudcomputing. In accordance with one embodiment, one or more userinterfaces are provided as part of (or in conjunction with) theillustrated systems to permit users to interact with the systems.

The user interface device may be implemented as a graphical userinterface (GUI) containing display 104 or the like, or may be a link toother user input/output devices known in the art. Individual ones of aplurality of devices (for example, network/stand-alone computers,personal digital assistants (PDAs), WebTV (or other Internet-only)terminals, set-top boxes, cellular phones, screen phones, pagers,blackberry, smart phones, iPhone, iPad, table, peer/non-peertechnologies, kiosks, or other known (wired or wireless) communicationdevices, etc.) may similarly be used to execute one or more computerprograms (for example, universal Internet browser programs, dedicatedinterface programs, etc.) to allow users to interface with the systemsin the manner described. Database hardware and software can be developedfor access by users through personal computers, mainframes, and otherprocessor-based devices. Users may access and data stored locally onhard drives, CD-ROMs, stored on network storage devices through a localarea network, or stored on remote database systems through one or moredisparate network paths (for example, the Internet).

The database can be stored in storage devices or systems (for example,Random Access Memory (RAM), Read Only Memory (ROM), hard disk drive(HDD), floppy drive, zip drive, compact disk-ROM, DVD, bubble memory,flash drive, redundant array of independent disks (RAID), networkaccessible storage (NAS) systems, storage area network (SAN) systems,etc.). CAS (content addressed storage) may also be one or more memorydevices embedded within a CPU, or shared with one or more of the othercomponents, and may be deployed locally or remotely relative to one ormore components interacting with the memory or one or more modules. Thedatabase may include data storage device, a collection component forcollecting information from users or other computers into a centralizeddatabase, a tracking component for tracking information received andentered, a search component to search information in the database orother databases, a receiving component to receive a specific query froma user interface, and an accessing component to access centralizeddatabase. A receiving component is programmed for receiving a specificquery from one of a plurality of users. The database may also include aprocessing component for searching and processing received queriesagainst a data storage device containing a variety of informationcollected by a collection device.

The disclosed system may, in some embodiments, be a computer networkbased system. The computer network may take any wired/wireless form ofknown connective technology (for example, corporate or individual LAN,enterprise WAN, intranet, Internet, Wi-Fi, Virtual Private Network(VPN), combinations of network systems, etc.) to allow a server toprovide local/remote information and control data to/from otherlocations (for example, other remote database servers, remote databases,network servers/user interfaces, etc.). In accordance with oneembodiment, a network server may be serving one or more users over acollection of remote and disparate networks (for example, Internet,Wi-Fi, intranet, VPN, cable, special high-speed ISDN lines, etc.). Thenetwork may comprise one or more interfaces (for example, cards,adapters, ports) for receiving data, transmitting data to other networkdevices, and forwarding received data to internal components of thesystem (for example, 3-D printers, print heads, etc.).

In accordance with one embodiment of the present application, the datamay be downloaded in one or more textual/graphical formats (for example,RTF, PDF, TIFF, JPEG, STL, XML, XDFL, TXT etc.), or set for alternativedelivery to one or more specified locations (for example, via e-mail) inany desired format (for example, print, storage on electronic mediaand/or computer readable storage media such as CD-ROM, etc.). The usermay view the search results and underlying documents at the userinterface, which allows viewing of one or more documents on the samedisplay 104.

Mesh Formulations

In FIG. 5 , a mesh bag 70 is being printed. In some embodiments, meshbag 70 is formed from material extruded from print head 30. Mesh bag 70comprises a system of threads 72 which are extruded directly ontoprinting surface. Threads 72 may be extruded in various patterns, andmay be sized according to the requirements of a particular application.For example, threads 72 may be extruded from print head 30 in a weavepattern in which threads 72 are interwoven with one another such thateach thread 72 alternatingly interlaces above and below adjacent threads72. In other embodiments, threads 72 may be extruded in other ways. Forexample, horizontal rows of threads 72 may be extruded in a first step,and in second step vertical rows of threads 72 may be extruded on top ofthe horizontal rows. The threads 72 may include bone material 74 (e.g.,DBM particles, allograft tissue particles, cortical bone particles,etc.) uniformly disposed throughout the threads 72. The material to makethe threads 72 (e.g., biodegradable polymer) and the bone material 74may be combined into one print head or be in separate print heads andthen printed together or separately until the mesh bag 70 is formed. Aradiation source, such as laser may be configured to sinter the extrudedrows together to form mesh bag 70.

In some embodiments as shown in FIG. 5A, a completely printed mesh bag70 is formed having a continuous surface 75 formed from threads 72. Meshbag 70 includes oppositely positioned ends 77 and 79. There is no sealat these ends as mesh bag 70 was 3-D printed allowing for continuousmanufacture. Mesh bags 70 that are not manufactured by 3-D printingwould have seals on three of the four corners of the bag. In oneembodiment of the 3-D printed mesh bag 70, a bottom end 73 of mesh bag70 is the only one sealed so that contents do not fall out. In otherembodiments, an end 71 is open to allow placement of bone material intothe hollow region or compartment 81 of mesh bag 70. End 71 allowsentrance into the hollow region or compartment 81 of mesh bag 70, wherebone material is placed inside of it; the implant is then placed at abone defect and mesh bag 70 allows the osteoinductive factors to leavemesh bag 70 and allows influx of bone cells into mesh bag 70. Mesh bag70 is porous so as to allow influx and efflux of material.

In FIG. 5B, the hollow region or compartment 81 of mesh bag 70 is shownhaving end 71 of mesh bag 70. Mesh bag 70 is filled manually by hand orvia an automated process with bone particles 83 (for example, surfacedemineralized chips and fully demineralized fibers) for use to enhancebone growth. The computer system may have a sensor to determine theproper level of filling of mesh bag 70 with bone material.

In some embodiments, the dimensions of printing surface 12 allows forprinting mesh bag 70 of different dimensions and shapes that correspondto printing surface 12 (for example, circular, rectangular, square,etc.) The rotation of printing surface 12 shown as B in FIGS. 2 and 3 ,allows the implant (for example, mesh bag 70) to be printed continuouslyso that there is a reduced need for sealing the hollow region of theimplant. The computer system can calculate the proper volume, length,width, and thickness of the cover to match the volume, length, width,and thickness of the compartment and/or mesh bag 70.

In some embodiments, mesh bag 70 is flexible so that it can be packedflat and it extends between oppositely positioned ends 77 and 79. Insome embodiments, mesh bag 70 forms a cylindrical shape betweenoppositely positioned ends 77 and 79.

Threads 72 may be configured to allow ingrowth of cells while alsoretaining the osteogenic material within compartment 81 of mesh bag 70.In some embodiments, print head 30 is configured to extrude threads 72having a predetermined thickness. In some embodiments, threads 72 have athickness of about 0.01 mm to about 2.0 mm. In some embodiments, threads72 have a thickness of about 0.05 mm to about 1.0 mm, or about 0.1 toabout 0.5 mm. The thickness of threads 72 may be uniform along thelength of each thread, or varied across the length of each thread. Insome embodiments, some threads 72 have a greater thickness than otherthreads 72 in a mesh bag 70. Threads 72 may be sized to allow forcustomizable pore sizes between threads 72. In some embodiments, porousmesh bag 70 is configured to facilitate transfer of substances and/ormaterials surrounding the surgical site. Upon implantation to a surgicalsite, mesh bag 70 may participate in, control, or otherwise adjust, ormay allow penetration of mesh bag 70 by surrounding materials, such ascells or tissue.

In various embodiments, mesh bag 70 may be sized according to the needsof a particular application. For example, mesh bag 70 may includedimensions between about 1 mm to about 100 mm in diameter, shown as W inFIG. 5B. In some embodiments, mesh bag 70 includes a diameter D1 asillustrated in FIG. 5B of about 5 mm, 10 mm, 15 mm, 20 mm, 25 mm, 30 mm,35 mm, 40 mm, 45 mm, 50 mm, 55 mm, 60 mm, 65 mm, 70 mm, 75 mm, 80 mm, 85mm, 90 mm, 95 mm, or 100 mm. In some embodiments, mesh bag 70 includes alength or depth from about 0.1 cm to about 10 cm illustrated as L1 inFIG. 5B. In some embodiments, mesh bag 70 includes a length or depth ofabout 1 cm, 2 cm, 3 cm, 4 cm, 5 cm, 6 cm, 7 cm, 8 cm, 9 cm, or 10 cm.The desired dimensions can be selected by the user and the computersystem can print the implant according to the selection.

In various embodiments, based on the foregoing dimensions, the volume ofa 3-D printed tubular shaped mesh bag 70 can be easily calculated. Forexample, in some embodiments, a 3-D printed tubular mesh bag 70 having adiameter of 0.5 cm and a length of 0.1 cm would provide a volume of 0.02cc. In other embodiments, a 3-D printed tubular mesh bag 70 having adiameter of 1 cm and a length of 1 cm would provide a volume of 0.79 cc.In yet other embodiments, a 3-D printed tubular mesh bag 70 having adiameter of 1.5 cm and length of 3 cm would provide a volume of 5.3 cc.

In some embodiments, threads 72 are extruded onto printing surface 12 ina wave-like configuration having alternating peaks and crests. In someembodiments, printing surface 12 is rotated in alternating clockwise andcounterclockwise directions while material 40 is extruded onto thesurface to create sinusoidal shaped waves having evenly shaped curves onthe peaks and crests. In some embodiments, the peaks and crests of thewaves are pointed to impart variable characteristics to mesh bag 70. Insome embodiments, threads 72 are extruded adjacent to one another suchthat the peaks of a first thread 72 is extruded to contact the crest ofan adjacent second thread 72. In some embodiments, mesh bag 70 may becreated entirely from threads 72 having this configuration. Wave-shapedthreads 72 impart flexibility and stretchable characteristics onto themanufactured mesh bag 70. The wavelength of the wave-shaped threads 72may be altered to customize stretchability of mesh bag 70. For example,threads 72 having shorter wavelengths will be able to be stretched morethan threads 72 having longer wavelengths. In some embodiments, thestretchability of mesh bag 70 is uniform across its length. In someembodiments, mesh bag 70 includes regions of increased stretchabilityaccording to the needs of a surgical application.

The shape, mesh size, thickness, and other structural characteristics,of mesh bags 70, for example, architecture, may be customized for thedesired application. For example, to optimize cell or fluid migrationthrough the mesh, the pore size may be optimized for the viscosity andsurface tension of the fluid or the size of the cells. For example, poresizes between threads 72 on the order of approximately 100-200 μm may beused if cells are to migrate through the mesh. In other embodiments, thewave-shaped threads 72 may be extruded to have larger peaks and crestsand the size of the pores may be larger. For example, in someembodiments, the pore size between threads 72 may be about 0.1 mm toabout 5 mm, about 0.5 mm to about 3 mm, or about 1 mm to about 2 mm.Mesh size may be controlled by physically weaving threads 72 and bycontrolling the thickness of threads 72 extruded and sintered onprinting surface 12.

In various embodiments, mesh bag 70 made by 3-D printing device 10 mayhave varying degrees of permeability across its surface. It may bepermeable, semi-permeable, or non-permeable. Permeability may be withrespect to cells, to liquids, to proteins, to growth factors, to bonemorphogenetic proteins, or other. In further embodiments, material 40may be braided.

Mesh bag 70 may have any suitable configuration. For example, mesh bag70 may be 3-D printed onto a printing surface 12 having a variety ofshapes, such as, for example, a ring, a cylinder, a cage, a rectangularshape, a suture-like wrap, a continuous tube, or other configurations.Printing surface 12 provides a scaffold onto which mesh bag 70 is 3-Dprinted and from which mesh bag 70 derives its shape. In specificembodiments, mesh bag 70 may be formed as a thin tube designed to beinserted through catheters or an introducer tube; a rectangular shapedesigned to fit adjacent to spinal processes for posterolateral spinefusion; a cube; a rectangular prism like structure, as shown in FIG. 4 ,designed to fit between vertebral bodies or within cages for interbodyspinal fusion; a tube-like shape; relatively flat shapes; rectangularshapes; structures pre-shaped to fit around various implants (e.g.,dental, doughnut with hole for dental implants); or relatively elasticring-like structures that will stretch and then conform to shapes (e.g.rubber band fitted around processes). In an embodiment, wherein mesh bag70 is formed as a cage, the cage may comprise a plurality of crossedthreads 72, which define between them a series of openings for tissueingrowth. Any of these shapes may be used to contain osteogenic materialsuch as bone material, as discussed herein. Mesh bags 70 may be printedand sintered onto printing surface 12 in such a way as to have one openend, as shown in FIGS. 5A and 5B.

Additionally, the flexible character of the mesh material allows formesh bag 70 to be manipulated into a plurality of compartments. Forexample, in a tubular embodiment, the tube may be formed into aplurality of compartments by tying a cord around the tube at one or morepoints, or by other suitable mechanism such as crimping, twisting,knotting, stapling, or sewing and also including 3-D printing based on a3-D digital model as more particularly described in this application.

A suitable mesh bag 70 that can be made by 3-D printing device 10 of thecurrent application is the MAGNIFUSE® Bone Graft, available fromMedtronic, which comprises surface demineralized bone chips mixed withnon-demineralized cortical bone fibers or fully demineralized bonefibers sealed in an absorbable poly(glycolic acid) (PGA) mesh implant,bag or pouch.

In certain embodiments, a bone void can be filled by mesh bag 70containing bone material. Compartment 81 within mesh bag 70 can be atleast partially filled with a bone repair substance. In variousembodiments, at least partially filled as used herein, can mean that apercentage of the volume of a compartment 81 or hollow interior regionis at least 70% occupied, at least 75% occupied, at least 80% occupied,at least 85% occupied, at least 90% occupied, at least 95% occupied, or100% occupied. In various embodiments, a sensing means or sensor incommunication with the hollow compartment 81 of mesh bag 70 and alsocoupled to a computer processor can instruct the processor when adesired percentage volume of the compartment 81 was occupied. Theprocessor can then instruct the 3-D printer to generate a covering forenclosing the bone material within mesh bag 70. Mesh bag 70 can beinserted into an opening in the defect until the defect is substantiallyfilled. In various embodiments, substantially filled, as used herein,can mean that a percentage of the volume of a defect is at least 70%occupied, at least 75% occupied, at least 80% occupied, at least 85%occupied, at least 90% occupied, at least 95% occupied, or 100%occupied.

In some embodiments, mesh bag 70 may be labeled. Such labeling may bedone in any suitable manner and at any suitable location on mesh bag 70.In some embodiments, labeling may be done by using a silk screenprinting, using an altered weaving or knotting pattern, by usingdifferent colored threads 72, or other means. The labeling may indicateinformation regarding mesh bag 70. Such information might include a partnumber, donor ID number, number, lettering or wording indicating orderof use in the procedure or implant size, etc.

In one embodiment, mesh bag 70 may comprise a penetrable material at afirst compartment 81 configured for placement adjacent bone and asubstantially impenetrable material at a second compartment 81configured for placement adjacent soft tissue. For example, the poresize between threads 72 at a first region of mesh bag 70 may be sizedlarge enough to allow cell migration through mesh bag 70, but the poresize between threads 72 at a second region of mesh bag 70 may be sizedsmall enough (or may include a lack of pores altogether) to prevent cellmigration. Alternatively, material 40 of mesh bag 70 may have a uniformconfiguration such that adjacent compartments 81 may have substantiallyidentical characteristics. By way of example only, mesh bag 70 may havea porous surface that is positioned adjacent bone, and a separate oropposite surface that has a generally impenetrable surface that ispositioned adjacent soft tissue. Alternatively, mesh bag 70 may have onecompartment 81 that comprises a porous material, and a secondcompartment 81 that comprises a substantially impenetrable material.

For either single or multi-compartment mesh bags 70, mesh bag 70 may beclosed after filling substances. Accordingly, mesh bag 70 may beprovided in an unfilled, unsealed state immediately followingfabrication with 3-D printing device 10. After a substance for deliveryis placed in mesh bag 70, mesh bag 70 may be permanently or temporarilyclosed. Permanent closure may be, for example, by 3-D printing acovering for enclosing the bone material within compartment 81 of meshbag 70. Temporary closure may be by tying, fold lock, cinching, or othermeans. A temporarily closed mesh bag 70 can be opened without damagingmesh bag 70 during surgical implantation to add or remove substances inmesh bag 70.

Suitable adhesives for use for closing mesh bag 70 may include, forexample, cyanoacrylates (such as histoacryl, B Braun, which is n-butyl-2cyanoacrylate; or Dermabond, which is 2-octylcyanoacrylate), epoxy-basedcompounds, dental resin sealants, dental resin cements, glass ionomercements, polymethyl methacrylate, gelatin-resorcinol-formaldehyde glues,collagen-based glues, inorganic bonding agents such as zinc phosphate,magnesium phosphate or other phosphate-based cements, zinc carboxylate,L-DOPA (3,4-dihydroxy-L-phenylalanine), proteins, carbohydrates,glycoproteins, mucopolysaccharides, other polysaccharides, hydrogels,protein-based binders such as fibrin glues and mussel-derived adhesiveproteins, and any other suitable substance. Adhesives may be selectedfor use based on their bonding time; for example, in some circumstances,a temporary adhesive may be desirable, for example, for fixation duringthe surgical procedure and for a limited time thereafter, while in othercircumstances a permanent adhesive may be desired. Where compartment 81is made of a material that is resorbable, the adhesive can be selectedthat would adhere for about as long as the material is present in thebody.

In some embodiments, biological attachment may be via mechanisms thatpromote tissue ingrowth such as by a porous coating or ahydroxyapatite-tricalcium phosphate (HA/TCP) coating. Generally,hydroxyapatite bonds by biological effects of new tissue formation.Porous ingrowth surfaces, such as titanium alloy materials in a beadedcoating or tantalum porous metal or trabecular metal may be used andfacilitate attachment at least by encouraging bone to grow through theporous implant surface. These mechanisms may be referred to asbiological attachment mechanisms. In some embodiments, mesh bag 70 maybe attached to a tissue structure through a wrap, a suture, a wire, astring, an elastic band, a cable or a cable tie, or a combinationthereof. In some embodiments, the attachment mechanism can be (i)integral to the 3-D printed seamless biodegradable mesh bag 70 or (ii)is provided separately from the 3-D printed seamless biodegradable meshbag 70 and can be attached to the 3-D printed seamless biodegradablemesh bag 70 for use at an intended graft site.

In some embodiments, mesh bag 70 comprises an extruded material 40arranged in a mesh configuration. In some embodiments, material 40 ofmesh bag 70 is biodegradable. In some embodiments, mesh bag 70 includesonly one material which is uniformly extruded to form the entirety ofmesh bag 70. In some embodiments, mesh bag 70 comprises a blend ofsuitable materials 40. In some embodiments, a first group of threads 72may comprise a first material 40 and a second group of threads 72comprises a second material 40. In some embodiments, print head 30 isconfigured to extrude more than one type of material 40. In someembodiments, a first print head 30 is configured to extrude a firstmaterial 40 to form threads 72 and a second print head 30 is configuredto extrude a second material 40 to form threads 72.

In other embodiments, suitable materials include natural materials,synthetic polymeric resorbable materials, synthetic polymericnon-resorbable materials, and other materials. Natural mesh materialsinclude silk, extracellular matrix (such as DBM, collagen, ligament,tendon tissue, or other), silk-elastin, elastin, collagen, andcellulose. Synthetic polymeric resorbable materials include poly(lacticacid) (PLA), poly(glycolic acid) (PGA), poly(lactic acid-glycolic acid)(PLGA), polydioxanone, PVA, polyurethanes, polycarbonates, and others.

In various embodiments, material 40 of mesh bag 70 comprises a polymermatrix. In some embodiments, DBM fibers and/or DBM powder are suspendedin the polymer matrix to facilitate transfer of cells into and out ofmesh bag 70 to induce bone growth at the surgical site. In otherembodiments, mesh bag 70 further comprises mineralized bone fiberssuspended in the polymer matrix. In some embodiments, the DBM powder issuspended in the polymer matrix between the DBM fibers and themineralized bone fibers. In some embodiments, the DBM powder issuspended between the DBM fibers in the polymer matrix so as to reduceand/or eliminate gaps that exist between the fibers. In someembodiments, the DBM powder is suspended between the DBM fibers in thepolymer matrix to improve osteoinductivity for facilitating bone fusion,for example, interspinous process fusion.

In some embodiments, the polymer matrix comprises a bioerodible, abioabsorbable, and/or a biodegradable biopolymer that may provideimmediate release or sustained release. Examples of suitable sustainedrelease biopolymers include, but are not limited to, poly (alpha-hydroxyacids), poly (lactide-co-glycolide) (PLGA), polylactide (PLA),polyglycolide (PG), polyethylene glycol (PEG), conjugates of poly(alpha-hydroxy acids), poly(orthoester)s (POE), polyaspirins,polyphosphagenes, collagen, starch, pre-gelatinized starch, hyaluronicacid, chitosans, gelatin, alginates, albumin, fibrin, vitamin Ecompounds, such as alpha tocopheryl acetate, d-alpha tocopherylsuccinate, D,L-lactide, or L-lactide, caprolactone, dextrans,vinylpyrrolidone, polyvinyl alcohol (PVA), PVA-g-PLGA, PEGT-PBTcopolymer (polyactive), PEO—PPO-PAA copolymers, PLGA-PEO-PLGA, PEG-PLG,PLA-PLGA, poloxamer 407, PEG-PLGA-PEG triblock copolymers, SAIB (sucroseacetate isobutyrate), or combinations thereof. As persons of ordinaryskill in the art are aware, mPEG and/or PEG may be used as a plasticizerfor PLGA, but other polymers/excipients may be used to achieve the sameeffect. mPEG imparts malleability to the polymer. In some embodiments,these biopolymers may also be coated on mesh bag 70 to provide a desiredrelease profile or ingrowth of tissue. In some embodiments, the coatingthickness may be thin, for example, from about 5, 10, 15, 20, 25, 30,35, 40, 45 or 50 microns to thicker coatings 60, 65, 70, 75, 80, 85, 90,95, 100 microns to delay release of the substance from mesh implant 70.In some embodiments, the range of the coating on mesh bag 70 ranges fromabout 5 microns to about 250 microns or from about 5 microns to about200 microns.

In various embodiments, various components of mesh bag 70 comprisepoly(lactide-co-glycolide) (PLGA), polylactide (PLA), polyglycolide(PGA), D-lactide, D,L-lactide, L-lactide, D,L-lactide-co-ε-caprolactone,D,L-lactide-co-glycolide-co-ε-caprolactone, L-lactide-co-ε-caprolactoneor a combination thereof.

In some embodiments, material 40 of mesh bag 70 further comprises bonemorphogenetic proteins (BMPs), growth factors, antibiotics, angiogenesispromoting materials, bioactive agents or other actively releasingmaterials.

Mesh bag 70 may be used to deliver a substance comprising any suitablebiocompatible material. In specific embodiments, mesh bag 70 may be usedto deliver surface demineralized bone chips, optionally of apredetermined particle size, demineralized bone fibers, optionallypressed, and/or allograft. For embodiments wherein the substance isbiologic, the substance may be autogenic, allogenic, xenogenic, ortransgenic. Other suitable materials that may be positioned in mesh bag70 include, for example, protein, nucleic acid, carbohydrate, lipids,collagen, allograft bone, autograft bone, cartilage stimulatingsubstances, allograft cartilage, TCP, hydroxyapatite, calcium sulfate,polymer, nanofibrous polymers, growth factors, carriers for growthfactors, growth factor extracts of tissues, DBM, dentine, bone marrowaspirate, bone marrow aspirate combined with various osteoinductive orosteoconductive carriers, concentrates of lipid derived or marrowderived adult stem cells, umbilical cord derived stem cells, adult orembryonic stem cells combined with various osteoinductive orosteoconductive carriers, transfected cell lines, bone forming cellsderived from periosteum, combinations of bone stimulating and cartilagestimulating materials, committed or partially committed cells from theosteogenic or chondrogenic lineage, or combinations of any of the above.

In accordance with some embodiments, the material to be positioned inhollow compartment 81 of mesh bag 70 may be supplemented, furthertreated, or chemically modified with one or more bioactive agents orbioactive compounds. Bioactive agent or bioactive compound, as usedherein, refers to a compound or entity that alters, inhibits, activates,or otherwise affects biological or chemical events. For example,bioactive agents may include, but are not limited to, osteogenic orchondrogenic proteins or peptides; DBM powder; collagen, insolublecollagen derivatives, etc., and soluble solids and/or liquids dissolvedtherein; anti-AIDS substances; anti-cancer substances; antimicrobialsand/or antibiotics such as erythromycin, bacitracin, neomycin,penicillin, polymycin B, tetracyclines, biomycin, chloromycetin, andstreptomycins, cefazolin, ampicillin, azactam, tobramycin, clindamycinand gentamycin, etc.; immunosuppressants; anti-viral substances such assubstances effective against hepatitis; enzyme inhibitors; hormones;neurotoxins; opioids; hypnotics; anti-histamines; lubricants;tranquilizers; anti-convulsants; muscle relaxants and anti-Parkinsonsubstances; anti-spasmodics and muscle contractants including channelblockers; miotics and anti-cholinergics; anti-glaucoma compounds;anti-parasite and/or anti-protozoal compounds; modulators ofcell-extracellular matrix interactions including cell growth inhibitorsand antiadhesion molecules; vasodilating agents; inhibitors of DNA, RNA,or protein synthesis; anti-hypertensives; analgesics; anti-pyretics;steroidal and non-steroidal anti-inflammatory agents; anti-angiogenicfactors; angiogenic factors and polymeric carriers containing suchfactors; anti-secretory factors; anticoagulants and/or antithromboticagents; local anesthetics; ophthalmics; prostaglandins;anti-depressants; anti-psychotic substances; anti-emetics; imagingagents; biocidal/biostatic sugars such as dextran, glucose, etc.; aminoacids; peptides; vitamins; inorganic elements; co-factors for proteinsynthesis; endocrine tissue or tissue fragments; synthesizers; enzymessuch as alkaline phosphatase, collagenase, peptidases, oxidases and thelike; polymer cell scaffolds with parenchymal cells; collagen lattices;antigenic agents; cytoskeletal agents; cartilage fragments; living cellssuch as chondrocytes, bone marrow cells, mesenchymal stem cells; naturalextracts; genetically engineered living cells or otherwise modifiedliving cells; expanded or cultured cells; DNA delivered by plasmid,viral vectors, or other member; tissue transplants; autogenous tissuessuch as blood, serum, soft tissue, bone marrow, or the like;bioadhesives; bone morphogenetic proteins (BMPs including BMP-2);osteoinductive factor (IFO); fibronectin (FN); endothelial cell growthfactor (ECGF); vascular endothelial growth factor (VEGF); cementumattachment extracts (CAE); ketanserin; human growth hormone (HGH);animal growth hormones; epidermal growth factor (EGF); interleukins, forexample, interleukin-1 (IL-1), interleukin-2 (IL-2); human alphathrombin; transforming growth factor (TGF-beta); insulin-like growthfactors (IGF-1, IGF-2); parathyroid hormone (PTH); platelet derivedgrowth factors (PDGF); fibroblast growth factors (FGF, BFGF, etc.);periodontal ligament chemotactic factor (PDLGF); enamel matrix proteins;growth and differentiation factors (GDF); hedgehog family of proteins;protein receptor molecules; small peptides derived from growth factorsabove; bone promoters; cytokines; somatotropin; bone digesters;antitumor agents; cellular attractants and attachment agents;immuno-suppressants; permeation enhancers, for example, fatty acidesters such as laureate, myristate and stearate monoesters ofpolyethylene glycol, enamine derivatives, alpha-keto aldehydes; andnucleic acids.

In certain embodiments, the bioactive agent may be a drug. In someembodiments, the bioactive agent may be a growth factor, cytokine,extracellular matrix molecule, or a fragment or derivative thereof, forexample, a protein or peptide sequence such as RGD.

In some embodiments, the polymer material used to make mesh bag 70 mayhave a modulus of elasticity in the range of from about 1×10² to about6×10⁵ dynes/cm², or 2×10⁴ to about 5×10⁵ dynes/cm², or 5×10⁴ to about5×10⁵ dynes/cm².

Material 40 may have functional characteristics. Alternatively, othermaterials 40 having functional characteristics may be incorporated intomesh bag 70. Functional characteristics may include radiopacity,bacteriocidity, source for released materials, tackiness, etc. Suchcharacteristics may be imparted substantially throughout mesh bag 70 orat only certain positions or portions of mesh bag 70.

Suitable radiopaque materials include, for example, ceramics,mineralized bone, ceramics/calcium phosphates/calcium sulfates, metalparticles, fibers, and iodinated polymer (see, for example,WO/2007/143698). Polymeric materials may be used to form a bone graft ormesh bag 70 and be made radiopaque by iodinating them, such as taughtfor example in U.S. Pat. No. 6,585,755, herein incorporated by referencein its entirety. Other techniques for incorporating a biocompatiblemetal or metal salt into a polymer to increase radiopacity of thepolymer may also be used. Suitable bacteriocidal materials may include,for example, trace metallic elements. In some embodiments, tracemetallic elements may also encourage bone growth.

In some embodiments, mesh bag 70 may comprise a carrier material thatbecomes tacky upon wetting. Such material may be, for example, a proteinor gelatin based material. Tissue adhesives, including mussel adhesiveproteins and cryanocrylates, may be used to impart tackiness to mesh bag70. In further examples, alginate or chitosan material may be used toimpart tackiness to mesh bag 70. In further embodiments, an adhesivesubstance or material may be placed on a portion of mesh bag 70 or in aparticular region of mesh bag 70 to anchor that portion or region ofmesh bag 70 in place at an implant site.

Bone Material

In various embodiments, bone grafts, for example, mesh bags 70 made by3-D printing device 10 include compartments 81 to hold osteogenicmaterial, such as bone material. In various embodiments, the bonematerial may be particulated such as, for example, in bone chip, powderor fiber form. If the bone is demineralized, the bone may be made into aparticulate before, during or after demineralization. In someembodiments, the bone may be monolithic and may not be a particulate.

The bone may be milled and ground or otherwise processed into particlesof an appropriate size before or after demineralization. The particlesmay be particulate (for example, powder) or fibrous. The terms millingor grinding are not intended to be limited to production of particles ofa specific type and may refer to production of particulate or fibrousparticles. In certain embodiments, the particle size may be greater than25 microns, such as ranging from about 25 to about 2000 microns, or fromabout 25 to about 500 microns or from about 200 to about 5000 microns.In some embodiments, the size of the bone particles are less than 100microns. In some embodiments, the size of the bone particles are lessthan 500 microns.

After grinding, the bone particles may be sieved to select thoseparticles of a desired size. In certain embodiments, the particles maybe sieved though a 25 micron sieve, a 50 micron sieve, a 75 micronsieve, a 100 micron sieve, a 125 micron sieve, a 150 micron sieve, a 175micron sieve and/or a 200 micron sieve.

In some embodiments, the bone particles comprise DBM and/or mineralizedbone. In some embodiments, the size of the bone particles is less than25 microns. In some embodiments, the bone particle size is about 1, 2,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22,23 and/or 24 microns.

In various embodiments, the bone particles and/or the DBM and/ormineralized bone fibers have a sticky outer surface such that the boneparticles can adhere to DBM and/or mineralized bone fibers. In variousembodiments, the bone particles are naturally sticky. In someembodiments, an adhesive agent is applied to the bone particles and/orthe bone fibers comprising a bio-adhesive, glue, cement, cyanoacrylate,silicones, hot melt adhesives and/or cellulosic binders. In variousembodiments, the adhesive may be applied to the surface of the boneparticles by spraying or brushing. In some embodiments, a charge isapplied to the fibers and an opposite charge is applied to the boneparticles, (e.g., the technique of electrostatic precipitation). Thebone particles will be attracted to, and tenaciously adhere to, thesurface of the fiber. Any of these application techniques can berepeated one or more times to build up a relatively thick layer ofadherent bone particles on the surface of the fibers.

The bone particles can be applied directly to the DBM fiber and/or fullymineralized fiber and the mixture can be disposed in mesh bag 70. Insome embodiments, the bone material inserted into mesh bag 70 containspores having a pore size from about 0.5 to about 2,000 microns. In someembodiments, bone material inserted into mesh bag 70 contains poreshaving a pore size of from about 0.5, 5, 50, 100, 150, 200, 250, 300,350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, 1,000,1,050, 1,100, 1,150, 1,200, 1,250, 1,300, 1,350, 1,400, 1,450, 1,500,1,550, 1,600, 1,650, 1,700, 1,750, 1,800, 1,850, 1,900, 1,950 to about2,000 microns. In some embodiments, the pore size of the bone materialis uniform. In some embodiments, the pore size of bone material isnon-uniform and includes various pore sizes in the range from 0.5 toabout 2,000 microns. Alternatively, the DBM fiber, and DBM particles canbe placed in a polymer (for example, collagen) and inserted into aporous biodegradable graft body (for example, a pouch, container, meshbag, and the like).

Following shaving, milling or other technique whereby they are obtained,the bone material is subjected to demineralization in order to reduceits inorganic content to a very low level, in some embodiments, to notmore than about 5% by weight of residual calcium and preferably to notmore than about 1% by weight of residual calcium. Demineralization ofthe bone material ordinarily results in its contraction to some extent.

Bone used in the methods described herein may be autograft, allograft,or xenograft. In various embodiments, the bone may be cortical bone,cancellous bone, or cortico-cancellous bone. While specific discussionis made herein to demineralized bone matrix, bone matrix treated inaccordance with the teachings herein may be non-demineralized,demineralized, partially demineralized, or surface demineralized. Thisdiscussion applies to demineralized, partially demineralized, andsurface demineralized bone matrix. In one embodiment, the demineralizedbone is sourced from bovine or human bone. In another embodiment,demineralized bone is sourced from human bone. In one embodiment, thedemineralized bone is sourced from the patient's own bone (autogenousbone). In another embodiment, the demineralized bone is sourced from adifferent animal (including a cadaver) of the same species (allograftbone).

Any suitable manner of demineralizing the bone may be used.Demineralization of the bone material can be conducted in accordancewith known conventional procedures. For example, in a demineralizationprocedure, the bone materials useful for the implantable composition ofthis application are subjected to an acid demineralization step that isfollowed by a defatting/disinfecting step. The bone material is immersedin acid over time to effect its demineralization. Acids which can beemployed in this step include inorganic acids such as hydrochloric acidand organic acids such as peracetic acid, acetic acid, citric acid, orpropionic acid. The depth of demineralization into the bone surface canbe controlled by adjusting the treatment time, temperature of thedemineralizing solution, concentration of the demineralizing solution,agitation intensity during treatment, and other applied forces such asvacuum, centrifuge, pressure, and other factors such as known to thoseskilled in the art. Thus, in various embodiments, the bone material maybe fully demineralized, partially demineralized, or surfacedemineralized.

After acid treatment, the bone is rinsed with sterile water forinjection, buffered with a buffering agent to a final predetermined pHand then finally rinsed with water for injection to remove residualamounts of acid and buffering agent or washed with water to removeresidual acid and thereby raise the pH. Following demineralization, thebone material is immersed in solution to effect its defatting. Adefatting/disinfectant solution is an aqueous solution of ethanol, theethanol being a good solvent for lipids and the water being a goodhydrophilic carrier to enable the solution to penetrate more deeply intothe bone. The aqueous ethanol solution also disinfects the bone bykilling vegetative microorganisms and viruses. Ordinarily, at leastabout 10 to 40 weight percent by weight of water (e.g., about 60 to 90weight percent of defatting agent such as alcohol) should be present inthe defatting/disinfecting solution to produce optimal lipid removal anddisinfection within the shortest period of time. A concentration rangeof the defatting solution is from about 60 to 85 weight percent alcoholor about 70 weight percent alcohol.

Further in accordance with this application, the DBM material can beused immediately for preparation of the implant or it can be storedunder aseptic conditions, advantageously in a critical point dried stateprior to such preparation. In one embodiment, the bone material canretain some of its original mineral content such that the composition isrendered capable of being imaged utilizing radiographic techniques.

In various embodiments, this application also provides bone matrixcompositions comprising critical point drying (CPD) fibers DBM includesthe collagen matrix of the bone together with acid insoluble proteinsincluding bone morphogenetic proteins (BMPs) and other growth factors.It can be formulated for use as granules, gels, sponge material or puttyand can be freeze-dried for storage. Sterilization procedures used toprotect from disease transmission may reduce the activity of beneficialgrowth factors in the DBM. DBM provides an initial osteoconductivematrix and exhibits a degree of osteoinductive potential, inducing theinfiltration and differentiation of osteoprogenitor cells from thesurrounding tissues.

DBM preparations have been used for many years in orthopedic medicine topromote the formation of bone. For example, DBM has found use in therepair of fractures, in the fusion of vertebrae, in joint replacementsurgery, and in treating bone destruction due to underlying disease suchas rheumatoid arthritis. DBM is thought to promote bone formation invivo by osteoconductive and osteoinductive processes. The osteoinductiveeffect of implanted DBM compositions is thought to result from thepresence of active growth factors present on the isolated collagen-basedmatrix. These factors include members of the TGF-β, IGF, and BMP proteinfamilies. Particular examples of osteoinductive factors include TGF-β,IGF-1, IGF-2, BMP-2, BMP-7, parathyroid hormone (PTH), and angiogenicfactors. Other osteoinductive factors such as osteocalcin andosteopontin are also likely to be present in DBM preparations as well.There are also likely to be other unnamed or undiscovered osteoinductivefactors present in DBM.

In various embodiments, the DBM provided in the methods described inthis application is prepared from elongated bone fibers which have beensubjected to critical point drying. The elongated CPD bone fibersemployed in this application are generally characterized as havingrelatively high average length to average width ratios, also known asthe aspect ratio. In various embodiments, the aspect ratio of theelongated bone fibers is at least from about 50:1 to at least about1000.1. Such elongated bone fibers can be readily obtained by any one ofseveral methods, for example, by milling or shaving the surface of anentire bone or relatively large section of bone.

In other embodiments, the length of the fibers can be at least about 3.5cm and average width from about 20 mm to about 1 cm. In variousembodiments, the average length of the elongated fibers can be fromabout 3.5 cm to about 6.0 cm and the average width from about 20 mm toabout 1 cm. In other embodiments, the elongated fibers can have anaverage length from about 4.0 cm to about 6.0 cm and an average widthfrom about 20 mm to about 1 cm.

In yet other embodiments, the diameter or average width of the elongatedfibers is, for example, not more than about 1.00 cm, not more than 0.5cm or not more than about 0.01 cm. In still other embodiments, thediameter or average width of the fibers can be from about 0.01 cm toabout 0.4 cm or from about 0.02 cm to about 0.3 cm.

In another embodiment, the aspect ratio of the fibers can be from about50:1 to about 950:1, from about 50:1 to about 750:1, from about 50:1 toabout 500:1, from about 50:1 to about 250:1, or from about 50.1 to about100:1 Fibers according to this disclosure can advantageously have anaspect ratio from about 50:1 to about 1000:1, from about 50:1 to about950:1, from about 50:1 to about 750:1, from about 50:1 to about 600:1,from about 50.1 to about 350.1, from about 50:1 to about 200:1, fromabout 50:1 to about 100:1, or from about 50:1 to about 75:1.

In some embodiments, the chips to fibers ratio is about 90:10, 80:20,75:25, 70:30, 60:40, 50:50, 40.60, 30:70, 25:75, 20.80 and/or 10:90. Invarious embodiments, the ratio of surface demineralized chips to fibersis about 90:10, 80:20, 75:25, 70:30, 60:40, 50:50, 40:60, 30:70, 25:75,20:80 and/or 10:90. In some embodiments, a surface demineralized chipsto fully demineralized fibers ratio is about 90:10, 80:20, 75:25, 70:30,60:40, 50:50, 40:60, 30:70, 25:75, 20:80 and/or 10:90.

In some embodiments, the DBM fibers have a thickness of about 0.5-4 mm.In various embodiments, the DBM fibers have a thickness of about 0.5,0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5 and/or 4 mm. In variousembodiments, the ratio of DBM fibers to DBM powder is about 40:60 toabout 90:10 W/W, W/V or V/V. In some embodiments, the ratio ofmineralized bone fibers to DBM powder is about 25:75 to about 75:25 W/W,W/V or V/V. In various embodiments, the bone graft material comprisesDBM fibers and mineralized fibers in a ratio of 40:60 to about 90:10W/W, W/V or V/V. In some embodiments, the DBM fibers to DBM powderratio, mineralized bone fibers to DBM powder ratio and/or the DBM fibersand mineralized fibers ratio is from 5:95 to about 95:5 W/W, W/V or V/V.In some embodiments, the DBM fibers to DBM powder ratio, mineralizedbone fibers to DBM powder ratio and/or the DBM fibers and mineralizedfibers ratio is 5:95, 10:90, 15:85, 20:80, 25:75, 30:70, 35:65, 40:60,45:55, 50:50, 55:45, 60:40, 65:35, 70:30, 75:25, 80:20, 85:15, 90:10and/or 95:5 W/W, W/V or V/V.

In some embodiments, the bone material comprises demineralized bonematerial comprising demineralized bone, fibers, powder, chips,triangular prisms, spheres, cubes, cylinders, shards or other shapeshaving irregular or random geometries. These can include, for example,“substantially demineralized,” “partially demineralized,” or “fullydemineralized” cortical and/or cancellous bone. These also includesurface demineralization, where the surface of the bone construct issubstantially demineralized, partially demineralized, or fullydemineralized, yet the body of the bone construct is fully mineralized.

In various embodiments, the bone graft material comprises fully DBMfibers and surface demineralized bone chips. In some embodiments, theratio of fully DBM fibers to surface demineralized bone chips is from5:95 to about 95:5 fibers to chips. In some embodiments, the ratio offully DBM fibers to surface demineralized bone chips is 5:95, 10:90,15:85, 20:80, 25:75, 30:70, 35:65, 40:60, 45:55, 50:50, 55:45, 60:40,65:35, 70:30, 75:25, 80:20, 85:15, 90:10 and/or 95:5 fibers to chips. Invarious embodiments, the fully DBM fibers have a thickness of about0.5-4 mm. In various embodiments, the fully DBM fibers have a thicknessof about 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5 and/or 4 mm.

In various embodiments, the fibers and/or the powder is surface DBM. Insome embodiments, the fibers and/or the powder is surface DBM corticalallograft. In various embodiments, surface demineralization involvessurface demineralization to at least a certain depth. For example, thesurface demineralization of the allograft can be from about 0.25 mm, 0.5mm, 1 mm, 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, 3.5 mm, 4 mm, 4.5 mm, to about5 mm. The edges of the bone fibers and/or powder may further be machinedinto any shape or to include features such as grooves, protrusions,indentations, etc., to help improve fit and limit any movement ormicromotion to help fusion and/or osteoinduction to occur.

To prepare the osteogenic DBM, a quantity of fibers is combined with abiocompatible carrier material to provide a demineralized bone matrix.

DBM typically is dried, for example via lyophilization or solventdrying, to store and maintain the DBM in active condition forimplantation. Moreover, each of these processes is thought to reduce theoverall surface area structure of bone. As may be appreciated, thestructural damage of the exterior surface reduces the overall surfacearea. Physical alterations to the surface and reduction in surface areacan affect cell attachment, mobility, proliferation, anddifferentiation. The surface's affinity for growth factors and releasekinetics of growth factors from the surface may also be altered.

Accordingly, in some embodiments, methods for drying bone to store andmaintain the bone in active condition for implantation that maintains orincreases the surface area of the bone are provided. In one embodiment,the bone matrix is treated using critical point drying (CPD) technique,thereby reducing destruction of the surface of the bone. While specificdescription is made to critical point drying, it is to be appreciatedthat, in alternative embodiments, super critical point treatment may beused. In various embodiments utilizing CPD, a percentage of collagenfibrils on the surface of the bone are non-denatured after drying to aresidual moisture content of approximately 15% or less. In someembodiments, after drying, the bone matrix has a residual moisturecontent of approximately 8% or less. In some embodiments, after drying,the bone matrix has a residual moisture content of approximately 6% orless. In some embodiments, after drying, the bone matrix has a residualmoisture content of approximately 3% or less.

Evaporative drying and freeze drying of specimens can cause deformationand collapse of surface structures, leading to a decrease in surfacearea. Without wishing to be bound by a particularly theory, thisdeformation and structure is thought to occur because as a substancecrosses the boundary from liquid to gas, the substance volatilizes suchthat the volume of the liquid decreases. As this happens, surfacetension at the solid-liquid interface pulls against any structures towhich the liquid is attached. Delicate surface structures tend to bebroken apart by this surface tension. Such damage may be caused by theeffects of surface tension on the liquid/gas interface. Critical pointdrying is a technique that avoids effects of surface tension on theliquid/gas interface by substantially preventing a liquid/gas interfacefrom developing. Critical point or supercritical drying does not crossany phase boundary, instead passing through the supercritical region,where the distinction between gas and liquid ceases to apply. As aresult, materials dehydrated using critical point drying are not exposedto damaging surface tension forces. When the critical point of theliquid is reached, it is possible to pass from liquid to gas withoutabrupt change in state. Critical point drying can be used with bonematrices to phase change from liquid to dry gas without the effects ofsurface tension. Accordingly, bone dehydrated using critical pointdrying can retain or increase at least some of the surface structure andtherefore the surface area.

In some embodiments, critical point drying is carried out using carbondioxide. However, other mediums such as Freon, including Freon 13(chlorotrifluoromethane), may be used. Generally, fluids suitable forsupercritical drying include carbon dioxide (critical point 304.25 K at7.39 MPa or 31.1° C. at 1072 psi or 31.2° C. and 73.8 bar) and Freon(about 300 K at 3.5-4 MPa or 25 to 30° C. at 500-600 psi). Nitrous oxidehas similar physical behavior to carbon dioxide, but is a powerfuloxidizer in its supercritical state. Supercritical water is also apowerful oxidizer, partly because its critical point occurs at such ahigh temperature (374° C.) and pressure (3212 psi/647K and 22.064 MPa).

In some embodiments, the bone may be pretreated to remove water prior tocritical point drying. Thus, in accordance with one embodiment, bonematrix is dried using carbon dioxide in (or above) its critical pointstatus. After demineralization, bone matrix samples (in water) may bedehydrated to remove residual water content. Such dehydration may beobtained, for example, by using a series of graded ethanol solutions(for example, 20%, 50%, 70%, 80%, 90%, 95%, 100% ethanol in deionizedwater). In some embodiments, penetrating the tissue with a graded seriesof ethanol solutions or alcohols may be accomplished in an automatedfashion. For example, pressure and vacuum could be used to acceleratepenetration into the tissue.

Methods of Making a Mesh Implant

In various embodiments as shown in FIG. 10 , a computer implementedmethod 200 of fabricating a hollow structure, such as mesh bag 70,through use of a 3-D printing device 10 is provided. In someembodiments, the method includes step 210 for inputting instructions fora computer processor 102 to carry out the fabrication, step 220 foraligning printing surface 12, base 16 and print head 30 relative to oneanother, step 230 for depositing material 40 onto printing surface 12,step 240 for rotating printing surface 12 and moving base 16 to create amesh pattern, step 250 for solidifying material 40 on printing surface12, step 251 for 3-D printing of mesh bag 70 having compartment 81 thatis accessible through an opening, step 252 for filling compartment 81with bone material, step 253 for enclosing mesh bag 70 by 3-D printing acovering for enclosing the bone material within compartment 81 of meshbag 70 and step 260 for removing the 3-D formed and covered mesh bag 70.In some embodiments, the method comprises: rotating a print surface inalternating clockwise and counterclockwise directions, ejecting materialfrom a print head to the print surface to make a strand having awave-like pattern with alternating peaks and crests, and rotating theprint head such an angular distance to create a plurality ofinterconnected threads on the printing surface.

In some embodiments, a method for fabricating a hollow structure isprovided which includes providing a 3-D printing machine 10 having atable 14, a base 16 and a printing surface 12. In various embodiments,printing surface 12 is rotatable about an axis of rotation. Base 16 isconfigured for planar movement. Printing surface 12 is fixedly disposedwith table 14 such that lateral movement of base 16 causes lateralmovement of printing surface 12. In some embodiments, base 16 is movablein the x-y plane and is laterally movable in both the x axis and the yaxis for precise positioning of printing surface 12. Movement of base 16allows for positioning of printing surface 12 relative to extensionshaft 20 to facilitate depositing materials 40 onto printing surface 12,as discussed herein. 3-D printing device 10 further includes a printhead 30 to deposit material 40 onto printing surface 12. The depositmaterial 40 includes material used to make the mesh (e.g., biodegradablepolymer, biodegradable polymer and bioactive agent mixed together,biodegradable polymer and bone material mixed together, etc.).

In other embodiments, a processor 102 receives instructions for thefabrication of a mesh bag 70. A user may input instructions directlyinto 3-D printing device 10 or may input instructions into an externalcomputer in communication with processor 102. Processor 102 directsmovement of base 16, printing surface 12 and print head 30 relative toone another. Processor 102 also directs application of material 40 fromprint head 30 onto printing surface 12.

According to various aspects, a user loads a material reservoir (notshown) in communication with print head 30 with a suitable material 40.Material 40 may be in powder form, particulate form, gel form, or solidform. Processor 102 moves printing surface 12 and one or more printheads 30 into place relative to one another. Once positioned, print head30 begins to deposit material 40 onto printing surface 12. In someembodiments, print head 30 continuously deposits material 40 as printingsurface 12 is rotated and/or moved laterally along the x-y plane. Insome embodiments, printing surface 12 is rotated in the clockwise andcounterclockwise directions while base 16 moves laterally to formwave-shaped threads 72. The degree of rotation may be adjusted to impartflexible and stretchable qualities onto each of the formed threads 72.For example, threads 72 having shorter wavelengths will be able to bestretched more than threads 72 having longer wavelengths. In someembodiments, processor 102 directs rotation of printing surface 12 andlateral movement of base 16 to impart stretchability of mesh bag 70 thatis uniform across its length. In some embodiments, processor 102 directsvariable rotation of printing surface 12 and lateral movement of base 16such that mesh bag 70 includes regions of increased stretchabilityaccording to the needs of a surgical application.

The movement of base 16, printing surface 12 and print head 30 relativeto one another and the application of material 40 onto printing surface12 is repeated a number of times such that threads 72 encompass thesurface of printing surface 12. That is, each time a thread having awave-like shape is applied to printing surface 12, a similar thread 72is applied to printing surface 12 adjacent the first thread. In someembodiments, threads 72 are extruded adjacent to one another such thatthe peaks of a first thread 72 are extruded to contact the crest of anadjacent second thread 72. In some embodiments, mesh bag 70 may becreated entirely from threads 72 having this configuration.

In some embodiments, print head 30 deposits material 40 in powdered formonto printing surface 12. Material 40 must be sintered and/or melted toform threads 72. In some embodiments, a radiation source, such as laser60 may be used in conjunction with print head 30. Processor 102 directslaser 60 to be focused at a point on which material 40 has beendeposited adjacent print head 30. Processor 102 also provides power tolaser 60 during desired intervals to prevent unwanted damage to mesh bag70 and/or printing surface 12 according to the instructions. That is,laser 60 will emit a beam while sintering material 40 to create threads72, but will not emit a beam when printing surface 12 is beingrepositioned relative to print head 30. Once all desired sintering hasbeen completed, any excess material 40 may be brushed away from printingsurface 12 to be discarded or recycled.

In some embodiments, material 40 may be sintered through use oftemperature control unit 50 (e.g., a heating unit) as illustrated inFIG. 1 . Temperature control unit 50 provides energy to printing surface12 such that powdered material 40 melts and molds together. An amount ofheat may be provided such that material 40 melts quickly upon contactwith printing surface 12.

In some embodiments, printing surface 12 is heated or cooled usingtemperature control unit 50 to remove mesh bag 70. In some embodiments,printing surface 12 may be removed from 3-D printing device 10 andsubmerged in a solvent to loosen and remove mesh bag 70.

As shown in FIG. 9 , a computer implemented method for producing ahollow structure such as a mesh bag is illustrated. In a first step 110,a user or a designer generates a virtual image of the object or a 3-Ddigital model to be created with the 3-D printing machine, such as, forexample, mesh bag 70 including a virtual volume of compartment 81 toenclose the bone material therein and a virtual depth, thickness andvolume of mesh bag 70 and a covering configured for enclosingcompartment 81 of mesh bag 70. The computer can generate a virtual 3-Dimage of the cover including a virtual volume, length, and width of thecovering to be printed. Commercially available CAM software can make theCAD drawing/design of mesh bag 70 into a computer code, (for example,g-code). This code is sent to the device and the controller controls thedevice and the loading of print head 30 with material 40, the heatingand cooling temperature and time of material 40, laser emit time,rotation, rotation speed of printing surface 12, print head 30, table14, lateral movement of printing surface 12, print head 30, and table 14as well as other parameters. The controller device creates a medicalimplant from or in the material based on the 3-D digital model. In someembodiments the 3-D digital model of mesh bag 70 is generated based onthe 3-D image of an intended bone repair site. The 3-D image of a bonerepair site can be obtained by using (i) one or more X-ray images; (ii)a computer aided design (CAD) program: (iii) a cone beam imaging device;(iv) a computed tomography (CT) scan device; (v) a magnetic resonanceimaging (MRI); (vi) 3-D laser camera, or a combination thereof.

In a second step 112, processor 102 calculates the X, Y, Z and A₁ axes.The device employs Cartesian coordinate system (X, Y, Z) for 3-D motioncontrol and employs a 4th axis (A₁) for the rotation of printing surface12 (for example, 360 degrees) relative to print head 30. The implant canbe designed virtually in the computer with a CAD/CAM program, which ison a computer display. The user inputs specific parameters into thecomputer and then presses print on the display to start the 3-D printingmanufacturing. The computer logic programs the computer withinstructions for loading of print head 30 with material 40; applicationand thickness of the polymer from print head 30; the heating and coolingtemperature and time of the device; laser emit time; rotation; rotationspeed of printing surface 12, print head 30, and/or table 14; and/orlateral movement of printing surface 12, print head 30, and/or table 14as well as other parameters in accordance with the receivedinstructions. The controller device causes print head 30 to be locatedat the appropriate X, Y, Z coordinates for 3-D motion control andemploys a 4th axis (A₁) for the rotation of printing surface 12 (forexample, 360 degrees, 180 degrees, 120 degrees) relative to print head30 to make a medical implant from or in material 40. After the medicalimplant is produced on all or a portion of printing surface 12, it willhave compartment 81 or a hollow region which typically is greater thanthe diameter or thickness of printing surface 12 and can be removed by atool that engages printing surface 12. In some embodiments, the devicecan have a tool to etch, shape, and/or dry the implant before, during orafter it is removed from printing surface 12.

In a third step 114, processor 102 calculates the polymer applicationlocation and speed by planning coordination of printing surface 12 andprint head 30. In some embodiments, the current device does notmanufacture the implant device by printing material 40 in successivelayers to form the implant. In a fourth step 116 and a fifth step 118,processor 102 calculates the rotation of printing surface 12 and thelateral and/or backward and forward movement of printing surface 12 andprint head 30. In some embodiments, printing surface 12 of the currentapplication has the polymer continuously dispensed from print head 30and onto printing surface 12 as printing surface 12 rotates in 360degrees clockwise and/or counterclockwise relative to print head 30 andtable 14, and/or printing surface 12 can, in some embodiments, move in aforward, lateral, and/or backward direction so that the threads to makethe medical implant (for example, mesh bag 70) are formed in accordancewith the instructions received from the computer. In some embodiments,printing surface 12 of the current application has a heat sensitivepolymer disposed on it and then print head 30 receives instructions toheat the surface area to be removed (for example, by laser, heatingelement, or the like). In this way, threads 72 of the polymer are madeby removing the heated portions of the polymer and what is left onprinting surface 12 are threads 72 for the implant. Printing surface 12rotates in 360 degrees clockwise and/or counterclockwise relative toprint head 30 and table 14, and/or printing surface 12 can, in someembodiments, move in a forward, lateral, and/or backward direction sothat threads 72 make the medical implant (for example, mesh bag 70) areformed as the rest of the polymer is removed from printing surface 12 inaccordance with the instructions received from the computer.

In some embodiments, printing surface 12 of the current application hasthe polymer in dry powder form continuously dispensed from print head 30and onto printing surface 12 as printing surface 12 rotates in 360degrees clockwise and/or counterclockwise relative to print head 30 andtable 14, and/or printing surface 12 can, in some embodiments, move in aforward, lateral, and/or backward direction so that threads 72 make themedical implant (for example, mesh bag 70) are formed in accordance withthe instructions received from the computer. After, the powderapplication, which can be from print head 30 from a reservoir therein,print head 30 (for example, a laser 60 or heating element coupledthereto) can heat the powder polymer and form threads 72 for the medicalimplant.

Based on the above calculations, processor 102 calculates a projectedamount of time it will take to manufacture the medical implant in step120. In a subsequent step 122, processor 102 calculates the amount oftime it will take for the printed medical device to dry. In someembodiments, material 40 applied to printing surface 12 is temperaturesensitive and dries and/or cures through heating or cooling. In someembodiments, processor 120 directs temperature control unit 50 to heator cool printing surface 12. In some embodiments, processor 120 directslaser 60 to focus its beam on material 40 applied to printing surface 12to sinter and cure material 40.

In step 124, the data calculated by processor 102 is stored in memory100 for subsequent implementation. In some embodiments, processor 102processes and organizes the calculated data into memory 100. In someembodiments, processor 102 includes value-determining logic, developmentlogic, security logic, and/or analytical logic. In some embodiments,processor 102 updates memory 100 with any new calculation data receivedfrom the user. In some embodiments, there is a computer readable storagemedium storing instructions that, when executed by a computer, cause thecomputer to display options for a user to enter, view, and edit some orall features for manufacturing the implant including the loading ofprint head 30 with material 40; the heating and cooling temperature andtime of material 40; laser emit time; rotation angle; rotation speed ofprinting surface 12, print head 30 and/or table 14; lateral movement ofprinting surface 12, print head 30 and table 14; as well as otherparameters. The controller device creates a medical implant from or inmaterial 40 by instructions received from the computer. The deviceemploys Cartesian coordinate system (X, Y, Z) for 3-D motion control andemploys a 4th axis (A₁) for the rotation of printing surface 12 (forexample, 360 degrees) relative to print head 30.

In a final step 126, the user inputs a command to send the stored datato the printer to create the medical device. The user inputs specificparameters into the computer and then presses print on the display tostart the 3-D printing manufacturing. The computer logic causes thecomputer to execute loading of print head 30 with material 40; theheating and cooling temperature and time of the device; laser emit time;rotation; rotation speed of printing surface 12, print head 30, and/ortable 14; and/or lateral movement of printing surface 12, print head 30,and/or table 14; as well as other parameters. The controller devicecauses print head 30 to be located at the appropriate X, Y, Zcoordinates for 3-D motion control and employs a 4th axis (A₁) for therotation of printing surface 12 (for example, 360 degrees, 180 degrees,120 degrees) relative to print head 30 to make a medical implant from orin material 40.

Method of Making a Bone Graft

In various embodiments, a computer implemented method for producing abone graft is provided. The computer implemented method for producing abone graft includes obtaining a 3-D image of an intended bone graftsite, generating a 3-D digital model of the bone graft based on the 3-Dimage of the intended bone graft site, the 3-D digital model of the bonegraft being configured to fit within the intended bone graft site;storing the 3-D digital model previously obtained on a database coupledto a processor, the processor having instructions for retrieving thestored 3-D digital model of the bone graft, and the processor alsohaving instructions for combining a carrier material with, in or on abone material based on the stored 3-D digital model and for instructinga 3-D printer to produce the bone graft.

In some aspects, the computer implemented method produces the bone graftby combining the carrier material with the bone material and instructingthe 3-D printer to print the bone graft based on the stored 3-D digitalmodel. In other aspects, the computer implemented method produces thebone graft by instructing the 3-D printer to print the carrier materialand then print the bone material in or on the carrier based on thestored 3-D digital model. In yet other embodiments, the computerimplemented method produces a bone graft which is customized to theintended bone graft site.

In certain embodiments, the 3-D image of an intended bone graft site isa computed tomography image of an unhealthy bone graft site, based on acomputed tomography image of a healthy bone graft site. In otherembodiments, the 3-D image is obtained from (i) one or more X-rayimages; (ii) a computer aided design (CAD) program; (iii) a cone beamimaging device; (iv) a computed tomography (CT) scan device; (v) amagnetic resonance imaging (MRI) or a combination thereof.

Generally, in many implementations, the carrier material comprises abiodegradable polymer, a metal, or a combination thereof and the bonematerial comprises mineralized or demineralized bone.

In some embodiments, the bone graft includes biodegradable polymers.Exemplary biodegradable materials include lactide-glycolide copolymersof any ratio (e.g., 85:15, 40:60, 30:70, 25:75, or 20:80),poly(L-lactide-co-D,L-lactide), polyglyconate, poly(arylates),poly(anhydrides), poly(hydroxy acids), polyesters, poly(ortho esters),poly(alkylene oxides), polycarbonates, poly(propylene fumarates),poly(propylene glycol-co fumaric acid), poly(caprolactones), polyamides,polyesters, polyethers, polyureas, polyamines, polyamino acids,polyacetals, poly(orthoesters), poly(pyrolic acid), poly(glaxanone),poly(phosphazenes), poly(organophosphazene), polylactides,polyglycolides, poly(dioxanones), polyhydroxybutyrate,polyhydroxyvalyrate, polyhydroxybutyrate/valerate copolymers, poly(vinylpyrrolidone), biodegradable polycyanoacrylates, biodegradablepolyurethanes including glucose-based polyurethanes and lysine-basedpolyurethanes, and polysaccharides (e.g., chitin, starches, celluloses).In certain embodiments, the polymer used in the bone graft ispoly(lactide-co-glycolide). The ratio of lactide and glycolide units inthe polymer may vary. Particularly useful ratios are approximately45-80% lactide to approximately 44-20% glycolide. In certainembodiments, the ratio is approximately 50% lactide to approximately 50%glycolide. In other certain embodiments, the ratio is approximately 65%lactide to approximately 45% glycolide. In other certain embodiments,the ratio is approximately 60% lactide to approximately 40% glycolide.In other certain embodiments, the ratio is approximately 70% lactide toapproximately 30% glycolide. In other certain embodiments, the ratio isapproximately 75% lactide to approximately 25% glycolide. In certainembodiments, the ratio is approximately 80% lactide to approximately 20%glycolide. In certain of the above embodiments, lactide is D,L-lactide.In other embodiments, lactide is L-lactide. In certain particularembodiments, RESOMER® 824 (poly-L-lactide-co-glycolide) (BoehringerIngelheim) is used as the polymer in the bone graft. In certainparticular embodiments, RESOMER® 504 (poly-D,L-lactide-co-glycolide)(Boehringer Ingelheim) is used as the polymer in the bone graft. Incertain particular embodiments, PURASORB PLG (75/25poly-L-lactide-co-glycolide) (Purac Biochem) is used as the polymer inthe bone graft. In certain particular embodiments, PURASORB PG(polyglycolide) (Purac Biochem) is used as the polymer in the bonegraft. In certain embodiments, the polymer isPEGylated-poly(lactide-co-glycolide). In certain embodiments, thepolymer is PEGylated-poly(lactide). In certain embodiments, the polymeris PEGylated-poly(glycolide). In other embodiments, the polymer ispolyurethane. In other embodiments, the polymer is polycaprolactone.

In certain embodiments, the biodegradable polymer is a copolymer ofpoly(caprolactone) and poly(lactide). For polyesters such aspoly(lactide) and poly(lactide-co-glycolide), the inherent viscosity ofthe polymer ranges from about 0.4 dL/g to about 5 dLg. In certainembodiments, the inherent viscosity of the polymer ranges from about 0.6dL/g to about 2 dL/g. In certain embodiments, the inherent viscosity ofthe polymer ranges from about 0.6 dug to about 3 dL/g. In certainembodiments, the inherent viscosity of the polymer ranges from about 1dL/g to about 3 dL/g. In certain embodiments, the inherent viscosity ofthe polymer ranges from about 0.4 dL/g to about 1 dL/g. Forpoly(caprolactone), the inherent viscosity of the polymer ranges fromabout 0.5 dL/g to about 1.5 dL/g. In certain embodiments, the inherentviscosity of the poly(caprolactone) ranges from about 1.0 dL/g to about1.5 dL/g. In certain embodiments, the inherent viscosity of thepoly(caprolactone) ranges from about 1.0 dL/g to about 1.2 dLg. Incertain embodiments, the inherent viscosity of the poly(caprolactone) isabout 1.08 dL/g.

Natural polymers, including collagen, polysaccharides, agarose,glycosaminoglycans, alginate, chitin, and chitosan, may also beemployed. Tyrosine-based polymers, including but not limited topolyarylates and polycarbonates, may also be employed (Pulapura, et al.,“Tyrosine-derived polycarbonates: Backbone-modified “pseudo”-poly(aminoacids) designed for biomedical applications,” Biopolymers, 1992, 32:411-417; Hooper, et al., “Diphenolic monomers derived from the naturalamino acid α-L-tyrosine: an evaluation of peptide coupling techniques,”J. Bioactive and Compatible Polymers, 1995, 10:327-340, the contents ofboth of which are incorporated herein by reference). Monomers fortyrosine-based polymers may be prepared by reacting anL-tyrosine-derived diphenol compound with phosgene or a diacid (Hooper,1995; Pulapura, 1992). Similar techniques may be used to prepare aminoacid-based monomers of other amino acids having reactive side chains,including imines, amines, thiols, and the like. In one embodiment, thedegradation products include bioactive materials, biomolecules, smallmolecules, or other such materials that participate in metabolicprocesses.

Polymers may be manipulated to adjust their degradation rates. Thedegradation rates of polymers are well characterized in the literature(see Handbook of Biodegradable Polymers, Domb, et al., eds., HarwoodAcademic Publishers, 1997, the entire contents of which are incorporatedherein by reference). In addition, increasing the cross-link density ofa polymer tends to decrease its degradation rate. The cross-link densityof a polymer may be manipulated during polymerization by adding across-linking agent or promoter. After polymerization, cross-linking maybe increased by exposure to UV light or other radiation. Co-monomers ormixtures of polymers, for example, lactide and glycolide polymers, maybe employed to manipulate both degradation rate and mechanicalproperties.

In some embodiments, the bone graft comprises biodegradable polymeric ornon-polymeric material. In some embodiments, the biodegradable polymermay provide immediate release, or sustained release of the biologicallyactive material. For example, the biodegradable polymer comprisespolyether ether ketone (PEEK). In some embodiments, the bone graft maycomprise one or more poly (alpha-hydroxy acids), polyglycolide (PG),polyethylene glycol (PEG) conjugates of poly (alpha-hydroxy acids),polyorthoesters (POE), polyaspirins, polyphosphagenes, collagen,hydrolyzed collagen, gelatin, hydrolyzed gelatin, fractions ofhydrolyzed gelatin, elastin, starch, pre-gelatinized starch, hyaluronicacid, chitosan, alginate, albumin, fibrin, vitamin E analogs, such asalpha tocopheryl acetate, d-alpha tocopheryl succinate, D,L-lactide, orL-lactide, caprolactone, dextrans, vinylpyrrolidone, polyvinyl alcohol(PVA), PVA-g-PLGA, PEGT-PBT copolymer (polyactive), methacrylates,PEO—PPO-PAA copolymers, PLGA-PEO-PLGA, PEG-PLG, PLA-PLGA, poloxamer 407,PEG-PLGA-PEG triblock copolymers, POE, SAIB (sucrose acetateisobutyrate), polydioxanone, methylmethacrylate (MMA), MMA andN-vinylpyyrolidone, polyamide, oxycellulose, copolymer of glycolic acidand trimethylene carbonate, polyesteramides, polyether ether ketone,polymethylmethacrylate, silicone, hyaluronic acid, chitosan, orcombinations thereof.

In some embodiments, the bone graft may not be fully biodegradable. Forexample, the bone graft may comprise polyurethane, polyurea,polyether(amide), PEBA, thermoplastic elastomeric olefin, copolyester,and styrenic thermoplastic elastomer, steel, aluminum, stainless steel,titanium, metal alloys with high non-ferrous metal content and a lowrelative proportion of iron, carbon device, glass device, plastics,ceramics, methacrylates, poly (N-isopropylacrylamide), PEO—PPO-PEO(pluronics) or combinations thereof. Typically, these types of matricesmay need to be removed after a certain amount of time.

In some embodiments, the bone graft comprises biodegradable polymerscomprising one or more of poly(lactide-co-glycolide) (PLGA), polylactide(PLA), polyglycolide (PGA), D-lactide, D,L-lactide, L-lactide,D,L-lactide-co-ε-caprolactone, L-lactide-co-ε-caprolactone,D,L-lactide-co-glycolide-co-ε-caprolactone,poly(D,L-lactide-co-caprolactone), poly(L-lactide-co-caprolactone),poly(D-lactide-co-caprolactone), poly(D,L-lactide), poly(D-lactide),poly(L-lactide), poly(esteramide) or a combination thereof. In someembodiments, a biologically active material can be encapsulated in abiodegradable polymer.

In various embodiments, the particle size distribution of thebiodegradable polymer may be about 10 micrometers, 13 micrometers, 85micrometers, 100 micrometers, 151 micrometers, 200 micrometers and allsubranges therebetween. In some embodiments, at least 75% of theparticles have a size from about 10 micrometers to about 200micrometers. In some embodiments, at least 85% of the particles have asize from about 10 micrometers to about 200 micrometers. In someembodiments, at least 95% of the particles have a size from about 10micrometers to about 200 micrometers. In some embodiments, all of theparticles have a size from about 10 micrometers to about 200micrometers. In some embodiments, at least 75% of the particles have asize from about 20 micrometers to about 180 micrometers. In someembodiments, at least 85% of the particles have a size from about 20micrometers to about 180 micrometers. In some embodiments, at least 95%of the particles have a size from about 20 micrometers to about 180micrometers. In some embodiments, all of the particles have a size fromabout 20 micrometers to about 180 micrometers.

In some embodiments, the bone graft comprises one or more polymers(e.g., PLA, PLGA, etc.) having a MW of from about 15,000 to about150,000 Da or from about 25,000 to about 100,000 Da.

In some embodiments, the bone graft comprises at least one biodegradablematerial in a wt % of from about 99.5%, 99%, 98%, 97%, 96%, 95%, 94%,93%, 92%, 91%, 90%, 89%, 88%, 87%, 86%, 85%, 84%, 83%, 82%, 81%, 80%,79%, 78%, 76%, 75%, 74%, 73%, 72%, 71%, 70%, 65%, 60%, 55%, 50%, 45%,35%, 25%, 20%, 15%, 10%, to about 5% based on the total weight of thebone graft. In some embodiments, the biodegradable polymer comprises arange of about 0.1% to about 20% based on the total weight of the bonegraft. In some embodiments, the biodegradable polymer comprises a rangeof about 0.1% to about 15% based on the total weight of the bone graft.In some embodiments, the biodegradable polymer comprises 14%, 13%, 12%,110%, 10%, 90%, 8%, 7%, 6%, or 5% based on the total weight of the bonegraft.

In some embodiments, the biodegradable polymer is present in an amountof about 0.01 wt % to about 50 wt % or about 8.0 wt % to about 50 wt %of the bone graft. In some embodiments, the biodegradable polymer ispresent in an amount of about 0.1 wt % to about 10 wt %, about 10 wt %to about 20 wt %, about 20 wt % to about 30 wt %, about 30 wt % to about40 wt %, or about 40 wt % to about 50 wt %. In other embodiments, thebiodegradable polymer comprises 0.2 to 2% and the ceramic particlesabout 98 to 99.8% by weight of the bone graft.

Mannitol, trehalose, dextran, mPEG and/or PEG may be used as aplasticizer for the polymer. In some embodiments, the polymer and/orplasticizer may also be coated on the bone graft to provide a desiredrelease profile. In some embodiments, the coating thickness may be thin,for example, from about 5, 10, 15, 20, 25, 30, 35, 40, 45 or 50 micronsto thicker coatings 60, 65, 70, 75, 80, 85, 90, 95 or 100 microns todelay release of a biologically active material from the bone graft. Insome embodiments, the range of the coating on the bone graft ranges fromabout 5 microns to about 250 microns or 5 microns to about 200 micronsto delay release from the bone graft.

In various embodiments, the carrier material can be a metal, for examplea biodegradable metal. The term “biodegradable metal” (BM) has beengenerally used to describe degradable metallic biomaterials for medicalapplications. Useful biodegradable metals include without limitationmagnesium based BMs including pure magnesium, magnesium-calcium alloy,magnesium zinc alloy and iron based BMs include pure iron, ironmanganese alloys.

In another embodiment, a magnesium alloy may include from about 90 toabout 98 weight % magnesium, from about 0 to about 6 weight % aluminum,from about 0 to about 2 weight % zinc, and from about 0 to about 3% rareearth metal(s). In another embodiment, the magnesium alloy may be AE42,which includes 94 weight % magnesium, 4 weight % aluminum, and 2 weight% rare earth metal(s).

In various implementations, the bone material useful for the computerimplemented method for producing the bone graft of this application andwhich can be used with a 3-D printer includes allograft, demineralizedbone matrix fiber, demineralized bone chips or a combination thereof.

In accordance with some embodiments, the carrier material for use by the3-D printer with, in or on a bone material may be supplemented, furthertreated, or chemically modified with one or more bioactive agents orbioactive compounds. Bioactive agent or bioactive compound, as usedherein, refers to a compound or entity that alters, inhibits, activates,or otherwise affects biological or chemical events. For example,bioactive agents may include, but are not limited to, osteogenic orchondrogenic proteins or peptides; DBM powder; collagen, insolublecollagen derivatives, etc., and soluble solids and/or liquids dissolvedtherein; anti-AIDS substances; anti-cancer substances; antimicrobialsand/or antibiotics such as erythromycin, bacitracin, neomycin,penicillin, polymycin B, tetracyclines, biomycin, chloromycetin, andstreptomycins, cefazolin, ampicillin, azactam, tobramycin, clindamycinand gentamycin, etc.; immunosuppressants; anti-viral substances such assubstances effective against hepatitis; enzyme inhibitors; hormones;neurotoxins; opioids; hypnotics; anti-histamines; lubricants;tranquilizers; anti-convulsants; muscle relaxants and anti-Parkinsonsubstances; anti-spasmodics and muscle contractants including channelblockers; miotics and anti-cholinergics; anti-glaucoma compounds;anti-parasite and/or anti-protozoal compounds; modulators ofcell-extracellular matrix interactions including cell growth inhibitorsand antiadhesion molecules; vasodilating agents; inhibitors of DNA, RNA,or protein synthesis; anti-hypertensives; analgesics; anti-pyretics;steroidal and non-steroidal anti-inflammatory agents; anti-angiogenicfactors; angiogenic factors and polymeric carriers containing suchfactors; anti-secretory factors; anticoagulants and/or antithromboticagents; local anesthetics; prostaglandins; anti-depressants;anti-psychotic substances; anti-emetics; imaging agents;biocidal/biostatic sugars such as dextran, glucose, etc.; amino acids;peptides; vitamins; inorganic elements; co-factors for proteinsynthesis; endocrine tissue or tissue fragments; synthesizers; enzymessuch as alkaline phosphatase, collagenase, peptidases, oxidases and thelike; polymer cell scaffolds with parenchymal cells; collagen lattices;antigenic agents; cytoskeletal agents; cartilage fragments; living cellssuch as chondrocytes, bone marrow cells, mesenchymal stem cells; naturalextracts; genetically engineered living cells or otherwise modifiedliving cells; expanded or cultured cells; DNA delivered by plasmid,viral vectors, or other member; tissue transplants; autogenous tissuessuch as blood, serum, soft tissue, bone marrow, or the like;bioadhesives; bone morphogenetic proteins (BMPs); osteoinductive factor(IFO); fibronectin (FN); endothelial cell growth factor (ECGF); vascularendothelial growth factor (VEGF); cementum attachment extracts (CAE);ketanserin; human growth hormone (HGH); animal growth hormones;epidermal growth factor (EGF); interleukins, for example, interleukin-1(IL-1), interleukin-2 (IL-2); human alpha thrombin; transforming growthfactor (TGF-beta); insulin-like growth factors (IGF-1, IGF-2);parathyroid hormone (PTH); platelet derived growth factors (PDGF);fibroblast growth factors (FGF, BFGF, etc.); periodontal ligamentchemotactic factor (PDLGF); enamel matrix proteins; growth anddifferentiation factors (GDF); hedgehog family of proteins; proteinreceptor molecules; small peptides derived from growth factors above;bone promoters; cytokines; somatotropin; bone digesters; antitumoragents; cellular attractants and attachment agents; immuno-suppressants;permeation enhancers, for example, fatty acid esters such as laureate,myristate and stearate monoesters of polyethylene glycol, enaminederivatives, alpha-keto aldehydes; and nucleic acids.

In certain embodiments, the bioactive agent may be a drug, a growthfactor, a protein or a combination thereof. In some embodiments, thebioactive agent may be a growth factor, cytokine, extracellular matrixmolecule, or a fragment or derivative thereof, for example, a protein orpeptide sequence such as RGD.

In some embodiments, the polymer may have a modulus of elasticity in therange of from about 1×10² dynes/cm² to about 6×10⁵ dynes/cm², or 2×10⁴to about 5×10⁵ dynes/cm², or 5×10⁴ to about 5×10⁵ dynes/cm².

Microspheres in the Carrier Material

In some embodiments, the bioactive agent included in the carriermaterial for use by the 3-D printer may be entrapped in a microsphere orpolymer beads prepared, for example, by coacervation techniques or byinterfacial polymerization, for example, hydroxymethylcellulose orgelatin-microcapsules and poly-(methylmethacylate) microcapsules,respectively, in colloidal drug delivery systems (for example,liposomes, albumin microspheres, microemulsions, nano-particles andnanocapsules) or in macroemulsions. Such techniques are disclosed inRemington's Pharmaceutical Sciences, 16th edition, Osol, A. Ed. (1980).

In certain implementations, the microspheres incorporated into thecarrier material are from about 1 μm to about 750 μm diameter in size.In other implementations the microspheres can vary from about 10, 20,30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180,190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320,330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460,470, 480, 490, 500, 510, 520, 530, 540, 550, 560, 570, 580, 590, 600,610, 620, 630, 640, 650, 660, 670, 680, 690, 700, 710, 720, 730, 740, toabout 750 μm diameter in size. In yet other aspects, the microspheresare porous and comprise pores having a size from about 1 μm to about 100μm. By adding a known amount of bioactive agent to the microspheres orpolymer beads present in the carrier material during the formation ofthe bone graft by 3-D printing, it is possible to control the deliverymechanism of the bioactive agent from the bone graft in a graded fashionpreventing too much of the bioactive agent to be released all at once.

In other aspects, a 3-D printer can prepare a 3-D bone graft bycombining a carrier material containing microspheres including bioactiveagents and a bone material, wherein the bone graft is printed on asubstrate that has load bearing strength, for example, a biocompatibleor biodegradable metal or other non-metallic graft. In various aspects,the microspheres of the carrier material can include additionaladditives, for examples drugs, growth factors, proteins or a combinationthereof.

Curable Ink

In several implementations, the carrier material comprises an ink thatdries, is cured or reacts to form a porous, biodegradable, biocompatiblematerial that is osteoinductive and has a load bearing strengthcomparable to bone. The ink can, in some aspects, be supplied in theform of a precursor powder and a precursor liquid. These may be fed toseparate containers in the 3-D printer. Prior to printing, a quantity ofthe precursor powder and the precursor liquid may be mixed to form theink to be used for printing the custom bone graft. The printing may beaccomplished by delivering quantities of the ink via a suitably sizedprint nozzle that may be moved in a raster scan with respect to thecustom bone graft being printed.

The precursor powder of the ink can contain a variety of ingredientssuch as, but not limited to, demineralized allograft bone matrix (DMB),a radical polymerization initiator, for example, dibenzoyl peroxide orsome combination thereof. The precursor liquid may contain a variety ofingredients such as, for example, methyl methacrylate (MMA), aradiopaque compound, an antibiotic, and a compound to increase thebiodegradability, or a combination thereof. In some aspects, aradiopaque compound can be, without limitations, zirconium dioxide orbarium sulfate or a combination thereof. In other aspects, usefulantibiotics include without limitation amoxicillin, doxycycline,gentamicin, clindamycin or a combination thereof. Other additives whichmay increase the biodegradability of the ink include, withoutlimitation, cellulose acetate (CA), cellulose acetate phthalate (CAP) ora combination thereof.

In alternate embodiments, the ink may include synthetic bonesubstitutes, and other slow reabsorbing biocompatible, bioactiveadhesives as discussed above. Examples of artificial bone substitutesinclude without limitation hydroxyapatite, synthetic calcium phosphateceramic or a combination thereof. These may be used instead of, or withnatural bone particulates such as without limitation allograft, fullydemineralized bone fibers and surface demineralized bone chips, or acombination thereof. These may be used with synthetically produced bonemorphogenetic agents such as, without limitation, recombinant human bonemorphogenetic protein rhBMP-2. Alternative inks may also include otherbiocompatible, bioactive adhesives such as, for example, glasspolyalkenoate cements, oleic methyl ester based adhesives, or acombination thereof.

In accordance with other embodiments, the carrier material for use bythe 3-D printer with, in or on a bone material may be supplemented withother microparticles and/or nanoparticles which can be incorporatedbefore or during 3-D printing in order to impart certain desirablemechanical, magnetic, piezoelectric properties and/or stimulate cellularfunctions upon implantation under a variety of in vivo or in vitroconditions to the custom made bone graft described in this disclosure.

Sterilization of the Bone Graft

In various aspects, the 3-D printed bone grafts obtained by the methodsof this application can be terminally sterilized as they are formed,during the curing process or in the final packaging step. In variousembodiments, one or more components of the bone graft may besterilizable by radiation in a terminal sterilization step in the finalpackaging. Terminal sterilization of a product provides greaterassurance of sterility than from processes such as an aseptic process,which require individual product components to be sterilized separatelyand the final package assembled in a sterile environment.

In various embodiments, gamma radiation is used in the terminalsterilization step, which involves utilizing ionizing energy from gammarays that penetrates deeply into the bone graft. Gamma rays are highlyeffective in killing microorganisms, they leave no residues nor havesufficient energy to impart radioactivity to the bone graft. Gamma rayscan be employed when the bone graft is in the package and gammasterilization does not require high pressures or vacuum conditions,thus, package seals and other components are not stressed. In addition,gamma radiation eliminates the need for permeable packaging materials.

In some embodiments, the bone graft may be packaged in a moistureresistant package and then terminally sterilized by gamma irradiation.In use, the surgeon removes one or all components from the sterilepackage for use.

In various embodiments, electron beam (e-beam) radiation may be used tosterilize one or more components of the bone graft. E-beam radiationcomprises a form of ionizing energy, which is generally characterized bylow penetration and high-dose rates. E-beam irradiation is similar togamma processing in that it alters various chemical and molecular bondson contact, including the reproductive cells of microorganisms. Beamsproduced for e-beam sterilization are concentrated, highly-chargedstreams of electrons generated by the acceleration and conversion ofelectricity.

Other methods may also be used to sterilize the bone graft and/or one ormore components of the bone graft, including, but not limited to, gassterilization, such as, for example, with ethylene oxide or steamsterilization.

Composite Ink

In various embodiments, an ink for use with a 3-D printer systemdescribed herein is a composite ink. In some aspects, the 3-D printercan use as ink a composite filament comprising a polymer and chips,microparticles, nanoparticles and/or fibers of demineralized bone,non-demineralized bone or a combination thereof. In some embodiments,the composite filament comprises a bioerodible polymer, one or moreceramics and demineralized bone matrix (DBM) where the demineralizedbone matrix particles are embedded within or coated on the surface ofthe bioerodible polymer and ceramic particles. In a further embodiment,the demineralized bone matrix particles are dispersed throughout thebioerodible polymer and ceramic particles. In some embodiments, thedemineralized bone matrix particles are dispersed homogeneouslythroughout the polymer and ceramic particles.

In certain embodiments, the composite filament comprises a combinationof fibers of demineralized bone matrix from allograft bone and fibers ofnon-allograft bone material, the fibers of non-allograft bone materialcomprising non-fibrous demineralized bone matrix particles embeddedwithin or disposed on the fibers of the non-allograft bone material.

In other embodiments, the fibers of non-allograft bone material comprisea bioerodible polymer and one or more ceramics either alone or incombination. In some embodiments, the fibers of non-allograft bonematerial comprise ceramics and collagen, hyaluronic acid, chitosan,keratin, and derivatives thereof, either alone or in combination. Insome embodiments, the bioerodible polymer is collagen. In someembodiments, the collagen is porous. In other embodiments, the diameterof the fibers of allograft bone and non-allograft bone material isbetween about 50 μm and about 1 mm. In some embodiments, the diameter ofthe fibers of allograft bone and non-allograft bone material is betweenabout 75 nm and about 250 nm. In some embodiments, the length of thefibers of the allograft bone and non-allograft material is between about5 mm and about 30 mm. In some embodiments, the composite filamentcomposition contains a bioactive agent. In some embodiments, the ceramicis a calcium phosphate ceramic and/or a silicon ceramic. In otherembodiments, the ceramic is tricalcium phosphate. In some embodiments,the ratio of fibers of demineralized bone matrix from allograft bone tofibers of non-allograft material ranges from about 80:20 to about 70:30,or from about 40:60 to about 60:40. In some embodiments, the ratio offibers of demineralized bone matrix from allograft bone to fibers ofnon-allograft material is about 50:50. In some embodiments, thenon-fibrous demineralized bone matrix particles embedded within ordisposed on the fibers of the non-allograft bone material range indiameter size from between about 50 μm and about 30 mm.

The fibers of the non-allograft bone material comprises a bioerodiblepolymer and a synthetic ceramic to which demineralized bone matrixparticles are embedded either within and/or on the surface of thenon-allograft bone material. The demineralized bone matrix particles arenon-fibrous. In other embodiments, the particles are powders,microspheres, sponges, pastes, gels, and/or granules. In one embodiment,the particles are powders.

DBM particles for use in the present disclosure can be obtainedcommercially or can be prepared by known techniques. In general,advantageous, osteoinductive DBM materials can be prepared bydecalcification of cortical and/or cancellous bone, often by acidextraction. This process can be conducted so as to leave collagen,noncollagenous proteins, and growth factors together in a solid matrix.Methods for preparing such bioactive demineralized bone matrix areknown, in respect of which reference can be made to U.S. Pat. Nos.5,073,373; 5,484,601; and 5,284,655, as examples. DBM products are alsoavailable commercially, including for instance, from sources such asRegeneration Technologies, Inc. (Alachua, Fla.), The American Red Cross(Arlington, Va.), and others. For the purposes of this disclosure, anyshape and particle size of DBM can be used, including DBM in the form offragments, slices, pellets, shavings, granules, chips, fibers, or powdera well as demineralized whole bones. In various embodiments, thedemineralized bone is of a small particle size, and in the form ofpowder. In certain embodiments, the particulate DBM material can have anaverage particle size of less than about 100 to about 1000 microns. Forinstance, the DBM material can have particle sizes in the range of 50 to850 microns. DBM materials that are solely osteoconductive can beprepared using similar techniques that have been modified orsupplemented to remove or inactivate (e.g., by crosslinking or otherwisedenaturing) components in the bone matrix responsible forosteoinductivity. Osteoinductive and/or osteoconductive DBM materialsused in the present disclosure can be derived from human donor tissue,especially in regard to implant devices intended for use in humansubjects.

In regard to the incorporated materials considered on a dry weightbasis, the particulate DBM material, which are embedded onto thenon-allograft fibers can constitute about 10% to about 50% of thecompositions, about 20% to about 40%, and about 25% to about 35% byweight. In various embodiments, particulate DBM material embedded ontothe non-allograft fibers can constitute about 10%, 11%, 12%, 13%, 14%,15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%,29%, 30%, 31%, 32%, 33%, 34%, 35%, 36%, 37%, 38%, 390%, 40%, 41%, 42%,43%, 44%, 45%, 46%, 47%, 48%, 49% or about 50% of the compositefilament. In a similar vein, composite filaments can contain about 5% toabout 30% by weight insoluble collagen particulate on a dry weightbasis, about 8% to about 20%, or about 10% to about 15%; and can containthe ceramics at a level of about 1% to about 20% on a dry weight basis,about 5% to about 15%, or about 8% to about 12%. It will be understood,however, that other amounts of these materials can be used within thebroader aspects of the present disclosure.

In some embodiments, the demineralized bone fibers of allograft bone andfibers of non-allograft bone have an average length to average thicknessratio or aspect ratio of the fibers from about 50:1 to about 1000:1. Inoverall appearance, the elongated demineralized bone fibers can be inthe form of threads, narrow strips, and/or thin sheets. The elongateddemineralized bone fibers can be substantially linear in appearance orthey can be coiled to resemble springs. In some embodiments, theelongated demineralized bone fibers are of irregular shapes including,for example, linear, serpentine and/or curved shapes. The elongated bonefibers can be demineralized however some of the original mineral contentmay be retained when desirable for a particular embodiment. The bonegraft composition of the composite filament may further comprisemineralized bone particles.

The bioerodible polymer will exhibit dissolution when placed in amammalian body and may be hydrophilic (e.g., collagen, hyaluronic acid,polyethylene glycol). Synthetic polymers are suitable according to thepresent disclosure, as they are biocompatible and available in a rangeof copolymer ratios to control their degradation.

In some embodiments, hydrophobic polymers (e.g.,poly(lactide-co-glycolyde), polyanhydrides) may be used. Alternatively,a combination of hydrophilic and hydrophobic polymers may be used in thebone graft composition of the disclosure.

Exemplary materials may include biopolymers and synthetic polymers suchas human skin, human hair, bone, collagen, fat, thin cross-linked sheetscontaining fibers and/or fibers and chips, polyethylene glycol (PEG),chitosan, alginate sheets, cellulose sheets, hyaluronic acid sheets, aswell as copolymer blends of poly (lactide-co-glycolide) PLGA.

In some embodiments, the particles disclosed herein can also includeother biocompatible and bioresorbable substances. These materials mayinclude, for example, natural polymers such as proteins andpolypeptides, glycosaminoglycans, proteoglycans, elastin, hyaluronicacid, dermatan sulfate, gelatin, or mixtures or composites thereof.Synthetic polymers may also be incorporated into the bone graftcomposites. These include, for example biodegradable synthetic polymerssuch as polylactic acid, polyglycolide, polylactic polyglycolic acidcopolymers (“PLGA”), polycaprolactone (“PCL”), poly(dioxanone),poly(trimethylene carbonate) copolymers, polyglyconate, poly(propylenefumarate), poly(ethylene terephthalate), poly(butylene terephthalate),polyethylene glycol, polycaprolactone copolymers, polyhydroxybutyrate,polyhydroxyvalerate, tyrosine-derived polycarbonates and any random or(multi-)block copolymers, such as bipolymer, terpolymer, quaterpolymer,that can be polymerized from the monomers related to previously-listedhomo- and copolymers.

In some embodiments, the bioerodible polymer is collagen. Collagen hasexcellent histocompatibility without antibody formation or graftrejection. Any suitable collagen material may be used, including knowncollagen materials, or collagen materials as disclosed in U.S. patentapplication Ser. No. 12/030,181, filed Feb. 12, 2008, herebyincorporated by reference in its entirety. Various collagen materialscan be used, alone or in combination with other materials.

Insoluble collagen material for use in the disclosure can be derivedfrom natural tissue sources, (e.g., xenogenic, allogenic, or autogenicrelative to the recipient human or other patient) or recombinantlyprepared. Collagens can be subclassified into several different typesdepending upon their amino acid sequence, carbohydrate content and thepresence or absence of disulfide crosslinks. Types I and III collagenare two of the most common subtypes of collagen and may be used in thepresent disclosure. Type I collagen is present in skin, tendon and bone,whereas Type III collagen is found primarily in skin. The collagen usedin compositions of the disclosure can be obtained from skin, bone,tendon, or cartilage and purified by methods well known in the art andindustry. Alternatively, the collagen can be purchased from commercialsources.

The collagen can be a telopeptide collagen and/or telopeptide collagen.Still further, either or both of non-fibrillar and fibrillar collagencan be used. Non-fibrillar collagen is collagen that has beensolubilized and has not been reconstituted into its native fibrillarform.

Suitable collagen products are available commercially, including forexample from Kensey Nash Corporation (Exton, Pa.), which manufactures afibrous collagen known as Semed F, from bovine hides. Collagen materialsderived from bovine hide are also manufactured by Integra Life ScienceHolding Corporation (Plainsboro, N.J.). Naturally-derived or recombinanthuman collagen materials are also suitable for use in the disclosure.Illustratively, recombinant human collagen products are available fromFibrogen, Inc. (San Francisco, Calif.).

The solid particulate collagen incorporated into the inventivecompositions can be in the form of intact or reconstituted fibers, orrandomly-shaped particles, for example. In certain embodiments, thesolid particulate collagen will be in the form of particles derived froma sponge material, for example by randomly fragmenting the spongematerial by milling, shredding or other similar operations. Suchparticulated sponge material can have an average maximum particlediameter of less than about 6 mm, less than about 3 mm, or in the rangeof about 0.5 mm to 2 mm. Such materials can, for example, be obtained bymilling or grinding a porous sponge material and sieving the milled orground material through a screen having openings sized about 6 mm orsmaller, or about 0.5 mm to about 2 mm. Retch grinders with associatedsieves are suitable for these purposes. Other sources of chemicallycrosslinked, particulate collagen, in fiber, irregular or other shapes,can also be used, and their use is considered to be another aspect ofthe present disclosure. These crosslinked particulate materials can beprovided as starting materials for preparing composite compositions asdisclosed herein, and therefore as incorporated in the bone graft, theseparticles are individually crosslinked. Crosslinked solid collagenparticles can be used in combination with non-crosslinked collagen incompositions of the disclosure, wherein the non-crosslinked collagen canbe solid (insoluble) or soluble collagen, or combinations thereof. Suchcrosslinked and non-crosslinked collagen mixtures can be used, forexample, to modulate the residence time of the collagen portion of thebone graft compositions in vivo.

Suitable crosslinking agents include, but are not limited to, mono- anddialdehydes, including glytaraldehyde and formaldehyde; polyepoxycompounds such as glycerol, and sugars such as glucose. In oneembodiment, the crosslinking agent is glycerol.

Exemplary collagen particles can be obtained from various collagensources including human or non-human (bovine, ovine, and/or porcine), aswell as recombinant collagen or combinations thereof. Examples ofsuitable collagen include, but are not limited to, human collagen typeI, human collagen type II, human collagen type III, human collagen typeIV, human collagen type V, human collagen type VI, human collagen typeVII, human collagen type VIII, human collagen type IX, human collagentype X, human collagen type XI, human collagen type XII, human collagentype XIII, human collagen type XIV, human collagen type XV, humancollagen type XVI, human collagen type XVII, human collagen type XVIII,human collagen type XIX, human collagen type XXI, human collagen typeXXII, human collagen type XXIII, human collagen type XXIV, humancollagen type XXV, human collagen type XXVI, human collagen type XXVII,and human collagen type XXVIII, or combinations thereof. Collagenfurther may comprise hetero- and homo-trimers of any of theabove-recited collagen types. In some embodiments, the collagencomprises hetero- or homo-trimers of human collagen type I, humancollagen type II, human collagen type III, or combinations thereof. Insome embodiments, the collagen is porous.

In some embodiments, the bioerodible polymer may be hyaluronic acid,chitosan, chitin, keratin, cellulose, glycosaminoglycans and derivativesthereof (e.g. esters of hyaluronic acid) or others of synthetic originwhich may be used as an alternative to or in combination with collagen.

In some embodiments, the synthetic ceramics disclosed herein may beselected from one or more materials comprising calcium phosphateceramics or silicon ceramics. Biological glasses such ascalcium-silicate-based bioglass, silicon calcium phosphate, tricalciumphosphate (TCP), biphasic calcium phosphate, calcium sulfate,hydroxyapatite, coralline hydroxyapatite, silicon carbide, siliconnitride (Si₃N₄), and biocompatible ceramics may be used. In someembodiments, the ceramic is tri-calcium phosphate or biphasic calciumphosphate and silicon ceramics. In some embodiments, the ceramic istricalcium phosphate.

In some embodiments, the ceramics are a combination of a calciumphosphate ceramic and a silicon ceramic. In some embodiments, thecalcium phosphate ceramic is resorbable biphasic calcium phosphate (BCP)or resorbable tri-calcium phosphate (TCP).

Biphasic calcium phosphate can have a tricalciumphosphate:hydroxyapatite weight ratio of about 50:50 to about 95:5,about 70:30 to about 95:5, about 80:20 to about 90:10, or about 85:15.The mineral material can be a granular particulate having an averageparticle diameter between about 0.2 and 5.0 mm, between about 0.4 and3.0 mm, or between about 0.4 and 2.0 mm.

The ceramics of the disclosure may also be oxide ceramics such asalumina (Al₂O₃) or zirconia (ZrO₂) or composite combinations of oxidesand non-oxides such as silicon nitride.

The ceramics of the disclosure may be porous and may have pore sizeslarge enough to permit osteoinduction via invasion of the material bybone forming cells. Examples of porous ceramics are hydroxyapatite andTCP.

In some embodiments, the non-allograft bone material includes from about40 to about 60 weight percent collagen, from about 20 to about 50 weightpercent DBM, and from about 10 to about 50 weight percent ceramics. Insome embodiments, the ratio of DBM particles to collagen and/or ceramicsis about 5:1, about 4:1, about 3:1, about 2:1, about 1:1, about 1:5,about 1:4, about 1:3, or about 1:2. In some embodiments, the ratio ofDBM particles to collagen and/or ceramics is about 1.5:0.5, about 1:1,or about 0.5:1.5.

In some embodiments, the particles disclosed herein also includesynthetic ceramics that are effective to provide a scaffold for bonegrowth and which are completely bioresorbable and biocompatible. Thesynthetic ceramics should provide high local concentrations of calcium,phosphate and silicon ions that act as a nidus for de-novo boneformation. The use of such resorbable ceramics provides many advantagesover alternative conventional materials. For instance, it eliminates theneed for post-therapy surgery for removal and degrades in the human bodyto biocompatible, bioresorbable products.

In other embodiments, the composite filament for use in a 3-D printersystem described herein is a curable composite ink. The composite inkcomprises a curable material and, optionally a colorant dispersed in theink, in amount from about 0.01 to about 5% by weight of the compositeink. In some cases, the colorant is present in the composite ink in anamount between about 0.01 and 3 weight %, between about 0.01 and 1weight %, between about 0.05 and 5 weight %, between about 0.05 and 3weight %, between about 0.05 and 1 weight %, between about 0.1 and 5weight %, between about 0.1 and 3 weight %, or between about 0.1 and 1weight %. In some aspects, the colorant of a composite ink comprises aninorganic pigment, such as TiO₂ and ZnO. In some embodiments, thecolorant of a composite ink comprises a colorant for use in a RGB, sRGB,CMY, CMYK, L*a*b*, or Pantone® colorization scheme. Moreover, in somecases, a particulate colorant described herein has an average particlesize of less than 500 nm, such as an average particle size of less than400 nm, less than 300 nm, less than 250 nm, less than 200 nm, or lessthan 150 nm. In some instances, a particulate colorant has an averageparticle size of 50-1000 nm, 50-500 nm, 50-400 nm, 50-300 nm, 50-200 nm,70-500 nm, 70-300 nm, 70-250 nm, or 70-200 nm.

In certain embodiments, the curable material included in the compositefilament is present in an amount up to about 99 weight %, up to about 95weight %, up to about 90 weight %, or up to about 80 weight %, based onthe total weight of the composite ink. In some cases, a composite inkdescribed herein comprises about 10-95 weight % curable material basedon the total weight of the carrier ink. In some embodiments, a carrierink comprises about 20-80 weight % curable material, about 30-70 weight% curable material, or about 70-90 weight % curable material.

In some cases, a curable material comprises one or more polymerizablecomponents. As used herein, a polymerizable component comprises acomponent that can be polymerized or cured to provide a 3-D printedarticle or object. In some embodiments, polymerizing or curing comprisesirradiating with electromagnetic radiation having sufficient energy toinitiate a polymerization or cross-linking reaction. In otherembodiments, ultraviolet (UV) radiation can be used.

In some embodiments, a polymerizable component comprises a monomericchemical species, such as a chemical species having one or morefunctional groups or moieties that can react with the same or differentfunctional groups or moieties of another monomeric chemical species toform one or more covalent bonds, such as in a polymerization reaction. Apolymerization reaction, in some embodiments, comprises a free radicalpolymerization, such as that between points of unsaturation, includingpoints of ethylenic unsaturation. In some embodiments, a polymerizablecomponent comprises at least one ethylenically unsaturated moiety, suchas a vinyl group or allyl group. In some embodiments, a polymerizablecomponent comprises an oligomeric chemical species capable of undergoingadditional polymerization, such as through one or more points ofunsaturation as described herein. In other embodiments, a polymerizablecomponent comprises one or more monomeric chemical species and one ormore oligomeric chemical species as described herein. A monomericchemical species and/or an oligomeric chemical species described hereincan have one polymerizable moiety or a plurality of polymerizablemoieties.

In some embodiments, a polymerizable component comprises one or morephoto-polymerizable or photo-curable chemical species. Aphoto-polymerizable chemical species, in some embodiments, comprises aUV-polymerizable chemical species. In some embodiments, a polymerizablecomponent is photo-polymerizable or photo-curable at wavelengths rangingfrom about 300 nm to about 400 nm. Alternatively, in some embodiments, apolymerizable component is photo-polymerizable at visible wavelengths ofthe electromagnetic spectrum.

In some embodiments, a polymerizable component described hereincomprises one or more species of (meth)acrylates including acrylate ormethacrylate or mixtures or combinations thereof. In other embodiments,a polymerizable component comprises an aliphatic polyester urethaneacrylate oligomer, a urethane (meth)acrylate resin, and/or an acrylateamine oligomeric resin, such as EBECRYL 7100. In yet other embodiments,a UV polymerizable or curable resin or oligomer can comprise anymethacrylate or acrylate resin which polymerizes in the presence of afree radical photoinitiator, is thermally stable in an exposed state forat least one week at a jetting temperature and for at least 4 weeks inan enclosed state, and/or has a boiling point greater than the jettingtemperature. In some embodiments, a polymerizable component has a flashpoint above the jetting temperature.

Urethane (meth)acrylates suitable for use in inks described herein, insome embodiments, can be prepared in a known manner, typically byreacting a hydroxyl-terminated urethane with acrylic acid or methacrylicacid to give the corresponding urethane (meth)acrylate, or by reactingan isocyanate-terminated prepolymer with hydroxyalkyl acrylates ormethacrylates to give the urethane (meth)acrylate. The weight averagemolecular weight of such (meth)acrylate oligomers is generally in therange from about 400 to 10,000, or from about 500 to 7,000. Urethane(meth)acrylates are commercially available from the SARTOMER Companyunder the product names CN980, CN981, CN975 and CN2901, or from BomarSpecialties Co. (Winsted, Conn.) under the product name BR-741. In someembodiments, a urethane (meth)acrylate oligomer has a viscosity rangingfrom about 140,000 cP to about 160,000 cP at about 50° C. or from about125,000 cP to about 175,000 cP at about 50° C. when measured in a mannerconsistent with ASTM D2983. In some embodiments described herein, aurethane (meth)acrylate oligomer has a viscosity ranging from about100,000 cP to about 200,000 cP at about 50° C. or from about 10,000 cPto about 300,000 cP at about 50° C. when measured in a manner consistentwith ASTM D2983.

In various embodiments, a polymerizable component comprises one or morelow molecular weight materials, such as methacrylates, dimethacrylates,triacrylates, and diacrylates, which can be used in a variety ofcombinations. In some embodiments, for example, a polymerizablecomponent comprises one or more of tetrahydrofurfuryl methacrylate,triethylene glycol dimethacrylate, 2-phenoxyethyl methacrylate, laurylmethacrylate, ethoxylated trimethylolpropane triacrylate, tricyclodecanedimethanol diacrylate, 2-phenoxyethylacrylate, triethylene glycoldiacrylate, a monofunctional aliphatic urethane acrylate, polypropyleneglycol monomethacrylate, polyethylene glycol monomethacrylate,cyclohexane dimethanol diacrylate, and tridecyl methacrylate.

In some embodiments, a polymerizable component comprises diacrylateand/or dimethacrylate esters of aliphatic, cycloaliphatic or aromaticdiols, including 1,3- or 1,4-butanediol, neopentyl glycol,1,6-hexanediol, diethylene glycol, triethylene glycol, tetraethyleneglycol, polyethylene glycol, tripropylene glycol, ethoxylated orpropoxylated neopentyl glycol, 1,4-dihydroxymethylcyclohexane,2,2-bis(4-hydroxycyclohexyl)propane or bis(4-hydroxycyclohexyl)methane,hydroquinone, 4,4′-dihydroxybiphenyl, bisphenol A, bisphenol F,bisphenol S, ethoxylated or propoxylated bisphenol A, ethoxylated orpropoxylated bisphenol F or ethoxylated or propoxylated bisphenol S.

A polymerizable component, in some embodiments, comprises one or moretri(meth)acrylates. In some embodiments, tri(meth)acrylates comprise1,1-trimethylolpropane triacrylate or methacrylate, ethoxylated orpropoxylated 1,1,1-trimethylolpropanetriacrylate or methacrylate,ethoxylated or propoxylated glycerol triacrylate, pentaerythritolmonohydroxy triacrylate or methacrylate, or tris(2-hydroxy ethyl)isocyanurate triacrylate.

In other embodiments, a polymerizable component of the compositefilament described herein comprises one or more higher functionalacrylates or methacrylates such as dipentaerythritol monohydroxypentaacrylate or bis(trimethylolpropane) tetraacrylate. In someembodiments, a (meth)acrylate of an ink has a molecular weight rangingfrom about 250 to 700.

In certain embodiments, a polymerizable component comprises allylacrylate, allyl methacrylate, methyl (meth)acrylate, ethyl(meth)acrylate, n-propyl (meth)acrylate, n-butyl (meth)acrylate,isobutyl (meth)acrylate, n-hexyl (meth)acrylate, 2-ethylhexyl(meth)acrylate, n-octyl (meth)acrylate, n-decyl (meth)acrylate andn-dodecyl (meth)acrylate, 2-hydroxyethyl (meth)acrylate, 2- and3-hydroxypropyl (meth)acrylate, 2-methoxyethyl(meth)acrylate,2-ethoxyethyl (meth)acrylate and 2- or 3-ethoxypropyl (meth)acrylate,tetrahydrofurfuryl methacrylate, 2-(2-ethoxyethoxyl)ethyl acrylate,cyclohexyl methacrylate, 2-phenoxyethyl acrylate, glycidyl acrylate,isodecyl acrylate, or a combination thereof.

Additional non-limiting examples of species of polymerizable componentsuseful in some embodiments described herein include the following:isobornyl acrylate (IBOA), commercially available from SARTOMER underthe trade name SR 506A: isobornyl methacrylate, commercially availablefrom SARTOMER under the trade name SR 423A; alkoxylatedtetrahydrofurfuryl acrylate, commercially available from SARTOMER underthe trade name SR 611; monofunctional urethane acrylate, commerciallyavailable from RAHN USA under the trade name GENOMER 1122; aliphaticurethane diacrylate, commercially available from ALLNEX under the tradename EBECRYL 8402; triethylene glycol diacrylate, commercially availablefrom SARTOMER under the trade name SR 272; triethylene glycoldimethacrylate, commercially available from SARTOMER under the tradename SR 205; tricyclodecane dimethanol diacrylate, commerciallyavailable from SARTOMER under the trade name SR 833S; tris(2-hydroxyethyl)isocyanurate triacrylate, commercially available from SARTOMERunder the trade name SR 368; and 2-phenoxyethyl acrylate, commerciallyavailable from SARTOMER under the trade name SR 339. Other commerciallyavailable curable materials may also be used.

The composite filament ink useful for the 3-D printing system describedin this disclosure can also include one or more additives selected fromthe group consisting of photoinitiators, inhibitors, stabilizing agents,sensitizers, and combinations thereof. In some embodiments, suitablephotoinitiators comprise benzoins, including benzoin, benzoin ethers,such as benzoin methyl ether, benzoin ethyl ether and benzoin isopropylether, benzoin phenyl ether and benzoin acetate, acetophenones,including acetophenone, 2,2-dimethoxyacetophenone and1,1-dichloroacetophenone, benzil, benzil ketals, such as benzil dimethylketal and benzil diethyl ketal, anthraquinones, including2-methylanthraquinone, 2-ethylanthraquinone, 2-tert-butylanthraquinone,1-chloroanthraquinone and 2-amylanthraquinone, triphenylphosphine,benzoylphosphine oxides, for example2,4,6-trimethylbenzoyldiphenylphosphine oxide (Lucirin TPO),benzophenones, such as benzophenone and4,4′-bis(N,N′-dimethylamino)benzophenone, thioxanthones and xanthones,acridine derivatives, phenazine derivatives, quinoxaline derivatives or1-phenyl-1,2-propanedione, 2-O-benzoyl oxime, 1-aminophenyl ketones or1-hydroxyphenyl ketones, such as 1-hydroxycyclohexyl phenyl ketone,phenyl 1-hydroxyisopropyl ketone and 4-isopropylphenyl1-hydroxyisopropyl ketone.

In some cases, suitable photoinitiators comprise those operable for usewith a HeCd laser radiation source, including acetophenones,2,2-dialkoxybenzophenones and 1-hydroxyphenyl ketones, such as1-hydroxycyclohexyl phenyl ketone or 2-hydroxyisopropyl phenyl ketone(2-hydroxy-2,2-dimethylacetophenone). Additionally, in other aspects,suitable photoinitiators comprise those operable for use with an Arlaser radiation source including benzil ketals, such as benzil dimethylketal. In some embodiments, a photoinitiator comprises anα-hydroxyphenyl ketone, benzil dimethyl ketal or2,4,6-trimethylbenzoyldiphenylphosphine oxide or a mixture thereof.

Other suitable photoinitiators comprise ionic dye-counter ion compoundscapable of absorbing actinic radiation and generating free radicals forpolymerization initiation. In some embodiments, inks containing ionicdye-counter ion compounds can be cured more variably with visible lightwithin the adjustable wavelength range of about 400 nm to about 700 nm.

A photoinitiator can be present in an ink described herein in any amountnot inconsistent with the objectives of the present disclosure. In someembodiments, a photoinitiator is present in an ink in an amount of up toabout 5 weight percent, based on the total weight of the ink. In someembodiments, a photoinitiator is present in an amount ranging from about0.1 weight percent to about 5 weight percent.

In some embodiments, a method of printing a 3-D bone graft comprisesselectively depositing layers of a composite ink described herein in afluid state onto a substrate. For example, in some cases, the compositefilament ink comprises a curable material and a colorant dispersed inthe curable material in an amount of about 0.01 to 5 weight %, based onthe total weight of the composite ink. Further, the layers of acomposite filament ink can be deposited according to an image of the 3-Dbone graft in a computer readable format. In some embodiments, the inkis deposited according to preselected computer aided design (CAD)parameters on to a metal or non-metal substrate.

Moreover, in some cases, one or more layers of a composite ink describedherein have a thickness of about 0.03 to about 5 mm, a thickness ofabout 0.03 to about 3 mm, a thickness of about 0.03 to about 1 mm, athickness of about 0.03 to about 0.5 mm, a thickness of about 0.03 toabout 0.3 mm, a thickness of about 0.03 to about 0.2 mm, a thickness ofabout 0.05 to about 5 mm, a thickness of about 0.05 to about 1 mm, athickness of about 0.05 to about 0.5 mm, a thickness of about 0.05 toabout 0.3 mm, or a thickness of about 0.05 to about 0.2 mm. Otherthicknesses are also possible.

A method described herein can also comprise curing the layers of thecomposite ink. In some embodiments, a method of printing a 3-D bonegraft further comprises subjecting the ink to electromagnetic radiationof sufficient wavelength and intensity to cure the ink, where curing cancomprise polymerizing one or more polymerizable functional groups of oneor more components of the ink. In some embodiments of printing a 3-Dbone graft, a layer of deposited ink is cured prior to the deposition ofanother or adjacent layer of ink.

In some embodiments, a preselected amount of ink described herein isheated to the appropriate temperature and jetted through the print heador a plurality of print heads of a suitable inkjet printer to form alayer on a print pad in a print chamber. In some embodiments, each layerof ink is deposited according to the preselected CAD parameters. Asuitable print head to deposit the ink, in some embodiments, is apiezoelectric print head. Additional suitable print heads for thedeposition of ink and support material described herein are commerciallyavailable from a variety of ink jet printing apparatus manufacturers.For example, Xerox, Hewlett Packard, or Ricoh print heads may also beused in some instances.

In some embodiments, a method of printing a 3-D article comprises usinga composite ink, wherein the composite ink remains substantially fluidupon deposition. In other embodiments, the ink exhibits a phase changeupon deposition and/or solidifies upon deposition. In some embodiments,the temperature of the printing environment can be controlled so thatthe jetted droplets of ink solidify on contact with the receivingsurface. In other embodiments, the jetted droplets of ink do notsolidify on contact with the receiving surface, remaining in asubstantially fluid state. In some embodiments, after each layer isdeposited, the deposited material is planarized and cured withelectromagnetic (e.g., UV) radiation prior to the deposition of the nextlayer. Optionally, several layers can be deposited before planarizationand curing, or multiple layers can be deposited and cured followed byone or more layers being deposited and then planarized without curing.Planarization corrects the thickness of one or more layers prior tocuring the material by evening the dispensed material to remove excessmaterial and create a uniformly smooth exposed or flat up-facing surfaceon the support platform of the printer.

In another embodiment, mechanical, magnetic, and/or piezoelectricsensitive micro-, nanoparticles or patterns are incorporated during 3-Dprinting to stimulate cellular functions upon implantation under avariety of in vivo or in vitro mechanical magnetic or pressureconditions.

FIG. 11 is a flow diagram of representative steps of a method, acomputer implemented method of producing a custom bone graft. The methodincludes step 701 for obtaining a 3-D image of the implant location orintended bone repair site including the topography of the bone repairsite or mesh bag 70, or the location of mesh bag 70. Step 701 can beaccomplished by using many known techniques of obtaining a 3-D imageincluding, but not limited to, (i) one or more X-ray images; (ii) acomputer aided design (CAD) program; (iii) a cone beam imaging device;(iv) a computed tomography (CT) scan device; (v) a magnetic resonanceimaging (MRI); or a combination thereof. In step 702, the imagesobtained in step 701 may be inputted into a suitable digital dataprocessor to create a 3-D model of a custom bone graft. In step 703,osteogenic material including, in some cases, polymers that preservesthe biological activity of demineralized bone particles and/or fibersand has a load bearing structure is supplied to form ink that can beused in steps 704 and 705. The load bearing structure, in some aspects,can be a metal or non-metal structure. In step 704, the 3-D printer mayfirst check to determine if the final layer has printed all the layersrequired to produce the custom bone graft.

These layers may have been provided by a programmed module operative ona digital data processing device, and may be the 3-D model of the custombone graft reduced to consecutive slices that when printed in thecorrect order, may result in the desired bone graft.

In step 705, the 3-D printer may print the next layer if the final layerhas not yet been printed. This may be done, for instance, by moving theprint nozzle in a raster fashion, depositing ink where required. Theprinting is performed in a sterilized environment.

In step 706, once the 3-D printer has printed all the required layersthat constitute the custom bone graft, the bone graft may undergo postprint processing. This post processing step may, for instance, includeactions such as, but not limited to, dissolving out the sucrosecrystals, if any are present, to provide a porous structure andsterilization of the custom bone graft.

In step 707, the 3-D printed custom bone graft is removed and may now beinserted into the patient at the intended bone repair site.

FIG. 12 is a flow diagram illustrating representative steps that thelogic performs for producing a bone graft according to an embodiment ofthis application. The computer is programmed for 3-D printing of a bonegraft by obtaining a 3-D image of an intended bone graft site, this canbe by taking one or more X-ray images, a computer aided design (CAD)program, a cone beam imaging device, a computed tomography (CT) scandevice, a magnetic resonance imaging (MRI) and the image can be scannedor input into the computer system in step 712. A 3-D digital model ofthe intended bone graft site is generated in step 714 based on the 3-Dimage of the intended bone graft site, the 3-D digital model of the bonegraft site including a virtual depth, thickness and volume of theintended bone graft site. Based on the 3-D image of the intended bonegraft site, a 3-D digital model of the custom bone graft is generated instep 716. For example, if the intended bone graft site has a bonedefect, the computer will generate a virtual 3-D model of the bone graftincluding a virtual depth, thickness and volume of the bone graft thatcan fit within the bone defect. Thus, a variety of 3-D models of thebone graft can be generated that will fit within the bone defect. Insome embodiments, the computer will create a variety of shapes and sizesof the bone graft that will fit within the bone defect and the user canselect the desired shape. In this way, a custom bone graft can beselected. The computer will store the digital models in step 718 on thedatabase.

The computer processor will have instructions to retrieve the stored 3-Ddigital model of the bone graft and combine a carrier material with, inor on the bone material based on the stored 3-D digital model of thebone graft in step 720. Thus, the computer will control the amount ofbone material and/or carrier used in the printing process either in oneor more printing heads to print the bone graft in step 722. The carrierin an ink that fills the printer can include the polymer, a bioactiveagent, bone material or a combination therefore used to manufacture thebone graft. For example, osteogenic material including, in some cases, apolymer that preserves the biological activity of demineralized boneparticles and/or fibers can be supplied to form ink that can be used insteps 720, 722, 724 and 726. In step 724, the computer may first checkto determine if the final layer has printed all the layers required toproduce the custom bone graft. These layers may have been provided by aprogrammed module operative on a digital data processing device, and maybe the 3-D model of the custom bone graft reduced to consecutive slicesthat when printed in the correct order, may result in the desired bonegraft.

In step 726, the 3-D printer may print the next layer if the final layerhas not yet been printed. This may be done, for instance, by moving theprint nozzle in a raster fashion, depositing ink where required. Theprinting may be performed in a sterilized environment.

In step 728, once the 3-D printer has printed all the required layersthat constitute the custom bone graft, the bone graft may undergo postprint processing. This post processing step may, for instance, includeactions such as, but not limited to, dissolving out the sucrosecrystals, if any are present, to provide a porous structure andsterilization of the custom bone graft.

Layered 3-D Printed Bone Graft

In certain embodiments, the computer implemented method described hereinprovides a layered 3-D printed bone graft. In some implementations, the3-D printed bone graft includes a first layer of biodegradable polymerfollowed by a second layer of bone material disposed on the first layerof biodegradable polymer, which is followed by a third layer ofbiodegradable polymer disposed on the second layer, each layer repeatinguntil a 3-D printer has completed the layered bone graft. In otherembodiments, the 3-D printed bone graft includes a first layer ofbiodegradable polymer mixed with bone material, a second layer ofbiodegradable polymer mixed with bone material, the second layerdisposed on the first layer, a third layer of biodegradable polymermixed with bone material, the third layer disposed on the second layer,each layer repeating until the 3-D printer has completed the layeredbone graft.

As discussed above in connection with the computer implemented methodfor producing the customized bone graft of this disclosure, in someembodiments, the bone material of the bone graft comprises (i)mineralized allograft and non-demineralized allograft or a combinationthereof; or (ii) allograft, demineralized bone matrix fiber anddemineralized bone chips or a combination thereof. In other embodiments,the layered 3-D printed bone graft contains bone material whichcomprises (i) fully demineralized bone fibers and surface demineralizedbone chips, or (ii) a demineralized bone matrix material comprisingfully demineralized bone matrix fibers and surface demineralized bonechips in a ratio of from about 25:75 to about 75:25.

FIG. 13 illustrates an embodiment of a 3-D printed bone graft that iscustom made to fit in the intended bone graft site. In FIG. 13 , a 3-Dprinted substantially cylindrically shaped bone graft 730 is shown,which contains bone material 732 that is partially enclosed by acontainer 734 made from a biodegradable polymer. This 3-D printedsubstantially cylindrically shaped bone graft 730 can be made using twoprint heads coupled to the computer system described above, where oneprint head contains the bone material 732 and the other print headcontains the biodegradable polymer used to make the container 734.First, the first print head can print the container 734 made from thebiodegradable polymer and then the second print head can print the bonematerial 732 (e.g., DBM particles) to fill the container 734 to make thesubstantially cylindrically shaped bone graft 730. The substantiallycylindrically shaped bone graft 730 is generated from a 3-D digitalmodel of an intended bone graft site, which is generated based on a 3-Dimage of the intended bone graft site (e.g., X-ray, CT image, MRI,etc.). The 3-D digital model of the intended bone graft site includes avirtual depth, thickness and volume of the bone graft site, the 3-Ddigital model of the bone graft being configured to fit within the 3-Ddigital model of the intended bone graft site. The 3-D digital models ofthe bone graft and the intended bone graft site are stored on thecomputer, and the computer system will retrieve the stored 3-D digitalmodel of the bone graft. When instructed, the computer will print thecarrier material (e.g., which can be a biodegradable polymer, abioactive agent or a combination thereof in a mixture) as the container734. The computer will then print the bone material 732 to form thesubstantially cylindrically shaped bone graft 730.

FIG. 14 illustrates a view of a human femur 736 showing a 3-D printedbone graft of the present application that is implanted into theintended bone graft site. In FIG. 14 , the intended bone graft site is asubstantially cylindrical bone defect in the human femur 736. The 3-Dprinted substantially cylindrically shaped bone graft 730, whichcontains bone material that is partially enclosed by a container 734made from a biodegradable polymer is shown implanted into the bonedefect in the human femur 736. In this way, the bone graft can beprinted to match the specific shape of the bone defect to have a bonegraft custom made based on the bone defect. This can eliminate the needto specifically shape the bone graft to the intended bone graft site. Inaddition, it can eliminate the need to shape the bone defect to adesired shape by drilling or creating a bone cavity to match the shapeof the implant.

In some embodiments, a variety of shapes and sizes of the 3-D digitalmodel can be provided to the user, which will allow the user to selectfrom a library of stored 3-D digital models of the bone graft based onthe 3-D digital models of the intended bone graft site. The computerwill perform the desired matching routine to match the intended bonegraft site with the bone graft. In some embodiments, the computer willprovide the preferred 3-D digital model of the bone graft with a 99.9%confidence interval that the user can select. Alternatively, the usercan select a bone graft that can be printed that can be molded by theclinician and then implanted. However, the implant will have the desiredvolume based on the 3-D digital model.

FIG. 15 illustrates a partial view of the human vertebral column 744showing a 3-D printed disc-shaped bone graft 738 of the presentapplication being implanted at an intended bone graft site, which is anintervertebral site 746. In FIG. 15 , the 3-D printed disc-shaped bonegraft 738 contains bone material 740 that surrounds a polymer 742 of theimplant. This 3-D printed disc-shaped bone graft 738 will mimic anatural vertebra as the polymer 742 will mimic the jelly likeconsistency of the nucleus pulposus and the bone material 740 willsurround the polymer 742. Therefore, the disc-shaped bone graft 738 canbe made using two print heads coupled to the computer system describedabove, where one print head contains the bone material 740 and the otherprint head contains the polymer 742 used to make the disc-shaped bonegraft 738. First, the first print head can print the bone material 740loaded in the printer in the shape of disc-shaped bone graft 738 andthen the second print head can print the polymer 742 inside the bonematerial 740 to make the disc-shaped bone graft 738. The disc-shapedbone graft 738 is generated from a 3-D digital model of an intended bonegraft site, which is generated based on a 3-D image of the intended bonegraft site (e.g., X-ray, CT image, MRI, etc.). The 3-D digital model ofthe intended bone graft site includes a virtual depth, thickness andvolume of the intended bone graft site. The 3-D digital model of thebone graft being configured to fit within the 3-D digital model of theintended bone graft site. The 3-D digital models of the bone graft andthe intended bone graft site are stored on the computer and the computersystem will retrieve the stored 3-D digital model of the bone graft onceinstructed and print the bone material 740 (e.g., bone particles in abinder) and then print the polymer 742 inside the bone material 740 toform the disc-shaped bone graft 738.

In various embodiments, as described above, the polymer of the carriermaterial comprises a curable biocompatible and/or biodegradable polymer.In these embodiments, the biodegradable polymer comprises at least oneof poly(lactic acid), poly(glycolic acid), poly(lactic acid-glycolicacid), polydioxanone, PVA, polyurethanes, polycarbonates,polyhydroxyalkanoates (polyhydroxybutyrates and polyhydroxyvalerates andcopolymers), polysaccharides, polyhydroxyalkanoates,polyglycolide-co-caprolactone, polyethylene oxide, polypropylene oxide,polyglycolide-co-trimethylene carbonate, poly(lactic-co-glycolic acid)or combinations thereof. In other embodiments, the biodegradable polymerfurther comprises at least one of a polymer sugar, protein, hydrophilicblock copolymer, hyaluronic acid, polyuronic acid, mucopolysaccharide,proteoglycan, polyoxyethylene, surfactant, polyhydroxy compound,polyhydroxy ester, fatty alcohol, fatty alcohol ester, fatty acid, fattyacid ester, liquid silicone, or combinations thereof.

In some uses, the carrier acts as a temporary scaffold until replaced bynew bone. Polylactic acid (PLA), polyglycolic acid (PGA), and variouscombinations have different dissolution rates in vivo. In bone, thedissolution rates can vary according to where the bone allograft isplaced.

FIG. 16 illustrates a cross-sectional view of a 3-D printed bone graft800 of the current application that is substantially cylindricallyshaped and has allograft tissue particles 804 partially enclosed bylayers of polymers 802 that are custom made to fit in the intended bonegraft site.

FIG. 17 illustrates an enlarged perspective view of a 3-D printed bonegraft 806 of the current application that has allograft tissue particles810 partially enclosed by layers of polymers that form strips 808 thatare custom made to fit in the intended bone graft site. These strips 808can be printed with varying widths, sizes and shapes. It will beunderstood that the ink or carrier used to print the bone graft can havethe polymer, bioactive agent, and/or bone material combined in onecarrier or ink to be delivered to one print head or be in separate inksor carriers and in separate print heads where the computer will instructthe print heads to print the bone graft.

The layered 3-D printed bone grafts obtained by the computer implementedmethod described herein are useful in many applications, includingwithout limitations, in oral maxillofacial surgery, dental implants,orthopedic surgery or any type of reconstructive hard tissue surgery, insome instances, in cortical or trabecular bone. In clinical use, thelayered 3-D printed bone grafts of this application allow not only forcustomizing to accommodate the anatomy of an individual patient, butalso, in some embodiments, can successfully be used to release aspecific drug from the bone graft to an intended bone repair site.

Accordingly, in some implementations, this application also provides amethod of treating a bone defect in a patient, the method comprisingadministering a layered 3-D printed bone graft to the intended bonedefect, wherein the layered 3-D printed bone graft comprises a firstlayer of biodegradable polymer; a second layer of bone material disposedon the first layer of biodegradable polymer; a third layer ofbiodegradable polymer disposed on the second layer, each layer repeatinguntil a 3-D printer has completed the layered bone graft. In otherimplementations, the method of treatment comprises administering alayered 3-D printed bone graft to the intended bone defect, wherein thelayered 3-D printed bone graft comprises a first layer of biodegradablepolymer mixed with bone material; a second layer of biodegradablepolymer mixed with bone material, the second layer disposed on the firstlayer; a third layer of biodegradable polymer mixed with bone material,the third layer disposed on the second layer, each layer repeating untilthe 3-D printer has completed the layered bone graft. In variousembodiments, the layered 3-D printed bone grafts described in thisdisclosure can be useful in treating bone defects caused byosteomyelitis or bone cancer.

In certain embodiments, when the 3-D printed bone graft is a mesh bag,any suitable method may be used for loading a bone material into meshbag 70. In some embodiments, the bone material may be spooned into themesh bag, placed in the mesh bag body using forceps, loaded into themesh bag using a syringe (with or without a needle), or inserted intothe mesh bag in any other suitable manner including using automation.

For placement, the substance or substances may be provided in the meshbag and placed in vivo, for example, at a bone defect. In oneembodiment, the mesh bag is placed in vivo by placing the mesh bag in acatheter or tubular inserter and delivering the mesh bag with thecatheter or tubular inserter. The mesh bag, with a substance providedtherein, may be steerable such that it can be used with flexibleintroducer instruments for, for example, minimally invasive spinalprocedures. For example, the bone graft may be introduced down a tubularretractor or scope, during XLIF, TLIF, or other procedures.

In clinical use, a delivery system comprising a mesh implant anddelivered substance may be used in any type of spinal fusion procedureincluding, for example, posterolateral fusion, interbody fusion (of anytype), facet fusion, spinous process fusion, anterior only fusion, orother fusion procedure. Examples of such spinal procedures includeposterior lumbar interbody fusion (PLIF), anterior lumbar fusion (ALIF)or posterior cervical or cervical interbody fusion approaches. In someembodiments, the mesh bag useful with TLIF, ALIF or XLIF procedures maybe tubular and have dimensions of approximately 2.5 cm in length andapproximately 0.5 cm in width. In other ALIF procedures, a mesh bag ofapproximately 1 cm by 1 cm can be used. In various embodiments, the meshbags may be tubular and may have dimensions of approximately 5 mm toapproximately 10 mm long and approximately 0.5 cm to 1 cm wide. In otherembodiments, the mesh implant or bag (with or without substance loaded)may be placed in a cage, for example, for interbody fusion.

In some embodiments, the 3-D printed mesh bag may be prefilled with asubstance for delivery and other compartments may be empty for fillingby the surgeon. In some embodiments, the 3-D mesh bag comprises a firstand a second compartment. In other embodiments, the first and secondcompartments of the 3-D mesh bag are in communication with each other.In several embodiments, one compartment may be bone filled while theother compartment of the 3-D mesh bag is not. In various embodiments,the 3-D printed seamless mesh bag conforms to surrounding bony contourswhen implanted in vivo.

The mesh bag may be used in any suitable application. In someembodiments, the mesh bag may be used in healing vertebral compressionfractures, interbody fusion, minimally invasive procedures,posterolateral fusion, correction of adult or pediatric scoliosis,treating long bone defects, osteochondral defects, ridge augmentation(dental/craniomaxillofacial, e.g., edentulous patients), beneath traumaplates, tibial plateau defects, filling bone cysts, wound healing,around trauma, contouring (cosmetic/plastic/reconstructive surgery), andothers. The mesh bag may be used in a minimally invasive procedure viaplacement through a small incision, via delivery through a tube, orother means. The size and shape may be designed with restrictions ondelivery conditions.

In some embodiments, the mesh bag is flexible enough so that it can befolded upon itself before it is implanted at, near, or in the bonedefect.

An exemplary application for using a mesh bag as disclosed is fusion ofthe spine. In clinical use, the mesh bag and delivered substance may beused to bridge the gap between the transverse processes of adjacent orsequential vertebral bodies. The mesh bag may be used to bridge two ormore spinal motion segments. The mesh bag surrounds the substance to beimplanted, and contains the substance to provide a focus for healingactivity in the body.

Generally, the mesh implant or bag may be applied to a pre-existingdefect, to a created channel, or to a modified defect. Thus, forexample, a channel may be formed in a bone, or a pre-existing defect maybe cut to form a channel, for receipt of the device. The mesh implant orbag may be configured to match the channel or defect. In someembodiments, the configuration of the mesh bag may be chosen to matchthe channel. In other embodiments, the channel may be created, or thedefect expanded or altered, to reflect a configuration of the mesh bag.The mesh bag may be placed in the defect or channel and, optionally,coupled using attachment mechanisms.

Although the invention has been described with reference to certainembodiments, persons skilled in the art will recognize that changes maybe made in form and detail without departing from the spirit and scopeof the invention.

1-13. (canceled)
 14. A layered 3-D printed bone graft, the layered bonegraft comprising: (i) a first layer of biodegradable polymer; a secondlayer of a bone material disposed on the first layer of biodegradablepolymer; and a third layer of biodegradable polymer disposed on thesecond layer, each layer repeating until a 3-D printer has completed thelayered bone graft; or (ii) a first layer of biodegradable polymer mixedwith the bone material; a second layer of biodegradable polymer mixedwith the bone material, the second layer disposed on the first layer;and a third layer of biodegradable polymer mixed with the bone material,the third layer disposed on the second layer, each layer repeating untilthe 3-D printer has completed the layered bone graft.
 15. The layered3-D printed bone graft of claim 14, wherein the bone material comprises(i) mineralized allograft bone, nondemineralized allograft bone or acombination thereof; or (ii) allograft bone, demineralized bone matrixfiber, demineralized bone matrix chips or a combination thereof.
 16. Thelayered 3-D printed bone graft of claim 14, wherein the bone materialcomprises (i) fully demineralized bone fibers and surface demineralizedbone chips; or (ii) a demineralized bone matrix material comprisingfully demineralized bone matrix fibers and surface demineralized bonechips in a ratio of from about 25:75 to about 75:25.
 17. The layered 3-Dprinted bone graft of claim 14, wherein the polymer comprises a curablepolymer comprising at least one of poly(lactic acid), poly(glycolicacid), poly(lactic acid-glycolic acid), polydioxanone, PVA,polyurethanes, polycarbonates, polyhydroxyalkanoates(polyhydroxybutyrates and polyhydroxyvalerates and copolymers),polysaccharides, polyhydroxyalkanoates polyglycolide-co-caprolactone,polyethylene oxide, polypropylene oxide, polyglycolide-co-trimethylenecarbonate, poly(lactic-co-glycolic acid) or combinations thereof. 18.The layered 3-D printed bone graft of claim 17, wherein the polymerfurther comprises at least one of a polymer sugar, protein, hydrophilicblock copolymer, hyaluronic acid, polyuronic acid, mucopolysaccharide,proteoglycan, polyoxyethylene, surfactant, polyhydroxy compound,polyhydroxy ester, fatty alcohol, fatty alcohol ester, fatty acid, fattyacid ester, liquid silicone, or combinations thereof. 19-20. (canceled)21. A layered 3-D printed bone graft, the layered 3-D printed bone graftcomprising a carrier material with, in or on a bone material, thecarrier material comprising a curable ink containing microspheres havingdiameters from about 1 μm to about 750 μm in size, the carrier materialand the bone material forming a mesh bag and a cover, the mesh bag beingfilled with a second bone material such that the mesh bag, the secondbone material and the cover form the layered 3-D bone graft, the layered3-D bone graft being configured to match a 3-D digital model of the bonegraft including a virtual depth, thickness and volume of the bone graftfitting within a 3-D digital model of an intended bone graft site. 22.The layered 3-D printed bone graft of claim 14, wherein the layered bonegraft comprises a carrier material with the bone material;
 23. Thelayered 3-D printed bone graft of claim 14, wherein the layered bonegraft is customized to an intended bone graft site.
 24. The layered 3-Dprinted bone graft of claim 22, wherein the bone material is printed inor on the carrier material.
 25. The layered 3-D printed bone graft ofclaim 22, wherein the carrier material comprises a metal, abiodegradable polymer or a combination thereof, and the bone materialcomprises mineralized or demineralized bone.